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Thromboembolic risk with gender-affirming hormone therapy: potential role of global coagulation and fibrinolysis assays

Gender-affirming hormonal therapies are a critical component of the care of transgender individuals. Transgender people are commonly prescribed estrogen or testosterone to promote male-to-female or female-to-male transitions and to preserve gender-specific characteristics long-term. However, some ex...

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Autores principales: Bouck, Emma G., Grinsztejn, Eduarda, Mcnamara, Megan, Stavrou, Evi X., Wolberg, Alisa S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10562871/
https://www.ncbi.nlm.nih.gov/pubmed/37822706
http://dx.doi.org/10.1016/j.rpth.2023.102197
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author Bouck, Emma G.
Grinsztejn, Eduarda
Mcnamara, Megan
Stavrou, Evi X.
Wolberg, Alisa S.
author_facet Bouck, Emma G.
Grinsztejn, Eduarda
Mcnamara, Megan
Stavrou, Evi X.
Wolberg, Alisa S.
author_sort Bouck, Emma G.
collection PubMed
description Gender-affirming hormonal therapies are a critical component of the care of transgender individuals. Transgender people are commonly prescribed estrogen or testosterone to promote male-to-female or female-to-male transitions and to preserve gender-specific characteristics long-term. However, some exogenous hormones, especially certain estrogen preparations, are an established risk factor of thrombosis. As the number of individuals seeking gender-based care is rising, there is an urgent need to identify and characterize the mechanisms underlying hormone-associated thrombosis and incorporate this information into clinical algorithms for diagnosis and management. Herein, we discuss historical evidence on the incidence of thrombosis and changes in plasma composition in transgender and cisgender cohorts. We present 3 case studies to demonstrate knowledge gaps in thrombosis risk stratification and prediction tools. We also present data from in vitro coagulation and fibrinolysis assays and discuss how information from these kinds of assays may be used to help guide the clinical management of transgender individuals.
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spelling pubmed-105628712023-10-11 Thromboembolic risk with gender-affirming hormone therapy: potential role of global coagulation and fibrinolysis assays Bouck, Emma G. Grinsztejn, Eduarda Mcnamara, Megan Stavrou, Evi X. Wolberg, Alisa S. Res Pract Thromb Haemost Review Article Gender-affirming hormonal therapies are a critical component of the care of transgender individuals. Transgender people are commonly prescribed estrogen or testosterone to promote male-to-female or female-to-male transitions and to preserve gender-specific characteristics long-term. However, some exogenous hormones, especially certain estrogen preparations, are an established risk factor of thrombosis. As the number of individuals seeking gender-based care is rising, there is an urgent need to identify and characterize the mechanisms underlying hormone-associated thrombosis and incorporate this information into clinical algorithms for diagnosis and management. Herein, we discuss historical evidence on the incidence of thrombosis and changes in plasma composition in transgender and cisgender cohorts. We present 3 case studies to demonstrate knowledge gaps in thrombosis risk stratification and prediction tools. We also present data from in vitro coagulation and fibrinolysis assays and discuss how information from these kinds of assays may be used to help guide the clinical management of transgender individuals. Elsevier 2023-09-02 /pmc/articles/PMC10562871/ /pubmed/37822706 http://dx.doi.org/10.1016/j.rpth.2023.102197 Text en © 2023 The Author(s) https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Review Article
Bouck, Emma G.
Grinsztejn, Eduarda
Mcnamara, Megan
Stavrou, Evi X.
Wolberg, Alisa S.
Thromboembolic risk with gender-affirming hormone therapy: potential role of global coagulation and fibrinolysis assays
title Thromboembolic risk with gender-affirming hormone therapy: potential role of global coagulation and fibrinolysis assays
title_full Thromboembolic risk with gender-affirming hormone therapy: potential role of global coagulation and fibrinolysis assays
title_fullStr Thromboembolic risk with gender-affirming hormone therapy: potential role of global coagulation and fibrinolysis assays
title_full_unstemmed Thromboembolic risk with gender-affirming hormone therapy: potential role of global coagulation and fibrinolysis assays
title_short Thromboembolic risk with gender-affirming hormone therapy: potential role of global coagulation and fibrinolysis assays
title_sort thromboembolic risk with gender-affirming hormone therapy: potential role of global coagulation and fibrinolysis assays
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10562871/
https://www.ncbi.nlm.nih.gov/pubmed/37822706
http://dx.doi.org/10.1016/j.rpth.2023.102197
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