Thrombophilia and hormonal therapy in transgender persons : a literature review and case series
- Author
- Marianne Kerrebrouck, Anna Vantilborgh (UGent) , Sarah Collet (UGent) and Guy T'Sjoen (UGent)
- Organization
- Abstract
- Background: Venous thromboembolism (VTE) is a rare side effect of hormonal therapy in transgender persons. Prothrombotic genetic variants can increase this risk. For this reason, previous VTE and/or genetic thrombophilia may be considered by some as contraindications to hormonal treatment. Aim: To formulate directions for clinical practice about the indications for thrombophilia screening and when to consider combination therapy of therapeutic anticoagulation and hormonal treatment as a safe alternative to withholding hormonal treatment. Methods: We conducted a literature search and describe a case series. All adult patients with gender dysphoria and a known prothrombotic genetic variant or history of VTE were invited by letter to participate in this study. Results: In our center, thrombophilia screening before start of hormonal treatment was restricted to those with a personal or family history of VTE. Sixteen individuals with a history of VTE and/or an underlying prothrombogenic condition were described. The time of follow up varied from 4 months to 20 years. Seven trans women had a positive thrombophilia screening (2 Factor V Leiden (FVL), 1 FVL + anticardiolipin antibodies, 1 FVL + high Factor VIII coagulant activity, 1 protein C deficiency, 1 prothrombin mutation, 1 positive lupus anticoagulant). Three trans women experienced an unprovoked VTE after start of hormonal therapy of which one lead to a positive thrombophilia screening. One VTE event in a trans woman was assumed to be provoked by surgery. Five trans men were identified with a prothrombogenic mutation (3 FVL, 1 protein C deficiency, 1 prothrombin mutation). One trans man, with a negative thrombophilia screen, experienced multiple provoked VTE events before start of hormonal therapy. Conclusion: Based on our literature review and case series we offer guidance when confronted with patients with previous VTE and/or genetic thrombophilia requesting hormonal interventions.
- Keywords
- FACTOR-V-LEIDEN, PROTEIN-C DEFICIENCY, DEEP-VEIN THROMBOSIS, VENOUS, THROMBOEMBOLISM, POSTMENOPAUSAL WOMEN, REPLACEMENT THERAPY, HEMOSTATIC, VARIABLES, FOLLOW-UP, TESTOSTERONE TREATMENT, ORAL-CONTRACEPTIVES, Anticoagulation, hormonal therapy, thrombophilia, thrombosis, transgender, case series, guidance
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Citation
Please use this url to cite or link to this publication: http://hdl.handle.net/1854/LU-8740232
- MLA
- Kerrebrouck, Marianne, et al. “Thrombophilia and Hormonal Therapy in Transgender Persons : A Literature Review and Case Series.” INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH, vol. 23, no. 4, 2022, pp. 377–91, doi:10.1080/26895269.2022.2025551.
- APA
- Kerrebrouck, M., Vantilborgh, A., Collet, S., & T’Sjoen, G. (2022). Thrombophilia and hormonal therapy in transgender persons : a literature review and case series. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH, 23(4), 377–391. https://doi.org/10.1080/26895269.2022.2025551
- Chicago author-date
- Kerrebrouck, Marianne, Anna Vantilborgh, Sarah Collet, and Guy T’Sjoen. 2022. “Thrombophilia and Hormonal Therapy in Transgender Persons : A Literature Review and Case Series.” INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 23 (4): 377–91. https://doi.org/10.1080/26895269.2022.2025551.
- Chicago author-date (all authors)
- Kerrebrouck, Marianne, Anna Vantilborgh, Sarah Collet, and Guy T’Sjoen. 2022. “Thrombophilia and Hormonal Therapy in Transgender Persons : A Literature Review and Case Series.” INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 23 (4): 377–391. doi:10.1080/26895269.2022.2025551.
- Vancouver
- 1.Kerrebrouck M, Vantilborgh A, Collet S, T’Sjoen G. Thrombophilia and hormonal therapy in transgender persons : a literature review and case series. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH. 2022;23(4):377–91.
- IEEE
- [1]M. Kerrebrouck, A. Vantilborgh, S. Collet, and G. T’Sjoen, “Thrombophilia and hormonal therapy in transgender persons : a literature review and case series,” INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH, vol. 23, no. 4, pp. 377–391, 2022.
@article{8740232, abstract = {{Background: Venous thromboembolism (VTE) is a rare side effect of hormonal therapy in transgender persons. Prothrombotic genetic variants can increase this risk. For this reason, previous VTE and/or genetic thrombophilia may be considered by some as contraindications to hormonal treatment. Aim: To formulate directions for clinical practice about the indications for thrombophilia screening and when to consider combination therapy of therapeutic anticoagulation and hormonal treatment as a safe alternative to withholding hormonal treatment. Methods: We conducted a literature search and describe a case series. All adult patients with gender dysphoria and a known prothrombotic genetic variant or history of VTE were invited by letter to participate in this study. Results: In our center, thrombophilia screening before start of hormonal treatment was restricted to those with a personal or family history of VTE. Sixteen individuals with a history of VTE and/or an underlying prothrombogenic condition were described. The time of follow up varied from 4 months to 20 years. Seven trans women had a positive thrombophilia screening (2 Factor V Leiden (FVL), 1 FVL + anticardiolipin antibodies, 1 FVL + high Factor VIII coagulant activity, 1 protein C deficiency, 1 prothrombin mutation, 1 positive lupus anticoagulant). Three trans women experienced an unprovoked VTE after start of hormonal therapy of which one lead to a positive thrombophilia screening. One VTE event in a trans woman was assumed to be provoked by surgery. Five trans men were identified with a prothrombogenic mutation (3 FVL, 1 protein C deficiency, 1 prothrombin mutation). One trans man, with a negative thrombophilia screen, experienced multiple provoked VTE events before start of hormonal therapy. Conclusion: Based on our literature review and case series we offer guidance when confronted with patients with previous VTE and/or genetic thrombophilia requesting hormonal interventions.}}, author = {{Kerrebrouck, Marianne and Vantilborgh, Anna and Collet, Sarah and T'Sjoen, Guy}}, issn = {{2689-5269}}, journal = {{INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH}}, keywords = {{FACTOR-V-LEIDEN,PROTEIN-C DEFICIENCY,DEEP-VEIN THROMBOSIS,VENOUS,THROMBOEMBOLISM,POSTMENOPAUSAL WOMEN,REPLACEMENT THERAPY,HEMOSTATIC,VARIABLES,FOLLOW-UP,TESTOSTERONE TREATMENT,ORAL-CONTRACEPTIVES,Anticoagulation,hormonal therapy,thrombophilia,thrombosis,transgender,case series,guidance}}, language = {{eng}}, number = {{4}}, pages = {{377--391}}, title = {{Thrombophilia and hormonal therapy in transgender persons : a literature review and case series}}, url = {{http://doi.org/10.1080/26895269.2022.2025551}}, volume = {{23}}, year = {{2022}}, }
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