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Perioperative Estrogen Considerations for Transgender Women Undergoing Vaginoplasty

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A Case-Based Guide to Clinical Endocrinology

Abstract

The mainstay of feminizing gender-affirming therapy for transgender people is a combination of estrogen and an adjunct anti-androgen. Exogenous estrogens are associated with greater risk of venous thromboembolism (VTE). The risk appears more significant with certain estrogens such as ethinyl estradiol. While ethinyl estradiol is the main estrogen used for oral contraceptive agents, there is no reason to accept its increased thrombogenicity for feminizing hormone therapy. For the estrogens studied, the risk seems to rise with higher doses and with the addition of progestins. That is the reason for the use of adjunct anti-androgens which may allow for similar benefits despite lower overall estrogen dosing. The absolute risk of VTE with exogenous estrogens, however, is small. Indeed, in the setting of major surgery, there does not appear to be any added benefit to holding estrogen therapy beyond standard perioperative VTE prophylaxis approaches.

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Authors and Affiliations

  1. Mount Sinai Center for Transgender Medicine and Surgery and Division of Endocrinology, Diabetes, and Bone Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Tamar Reisman & Joshua D. Safer

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  1. Tamar Reisman
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  2. Joshua D. Safer
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Correspondence to Tamar Reisman .

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Editors and Affiliations

  1. Thyroid Research Unit, Department of Medicine, Icahn School of Medicine at Mount Sinai and James J. Peters VA Medical Center, New York, NY, USA

    Terry F. Davies

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Reisman, T., Safer, J.D. (2022). Perioperative Estrogen Considerations for Transgender Women Undergoing Vaginoplasty. In: Davies, T.F. (eds) A Case-Based Guide to Clinical Endocrinology. Springer, Cham. https://doi.org/10.1007/978-3-030-84367-0_57

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  • DOI: https://doi.org/10.1007/978-3-030-84367-0_57

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-84366-3

  • Online ISBN: 978-3-030-84367-0

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