Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Transgender health risks in hormone therapy

Robert Killeen, MD
Conditions
July 27, 2023
Share
Tweet
Share

Reportedly, there are at least 1.6 million people who identify as transgendered in the United States. Approximately one-third of them are transgendered male-to-females, referred to as “T-girls.” These individuals have a strong desire to be passable without undergoing surgery, relying instead on hormone therapy. However, hormonal therapy is not without risks. Testosterone, used in protocols for transgendered males, can increase the chances of venous thromboembolism (VTE). Similarly, estrogen, used by T-girls, carries an inherent tendency towards clotting. While VTE occurs in 1-2 cases per 1000 in the general population, the incidence is nearly 20 times higher in the male-to-female (MTF) population due to hormone usage. Additionally, spironolactone, used by transgendered females to block androgen effects, can cause life-threatening hyperkalemia in individuals with compromised renal function. One of the most common gender-related compounds is estradiol, which supports the female phenotype but may also contribute to VTE and pose health risks to the patient. For those new to hormone therapy, the price of achieving a “feminine” appearance can be life-threatening. Transgendered individuals may not disclose their hormone use, so physicians’ only defenses against this hormonal toxicity are suspicion and cognition.

Estradiol disrupts the coagulatory balance in the bloodstream, increasing the likelihood of VTE. The risk of VTE rises with the duration of estradiol use. In a healthy individual, coagulation in the bloodstream is regulated by the interplay between the coagulation cascade and natural anticoagulants. However, estradiol alters this balance by increasing the concentrations of fibrinogen, von Willebrand’s factor, Prothrombin, and Factors 7 and 10. It also affects natural anticoagulants, reducing Protein S levels and causing acquired resistance to activated Protein C. Individuals with genetic coagulopathies such as Factor V Leiden or Factor 2 mutations face an even higher risk of VTE. The consequences of this disrupted coagulopathy can manifest as deep venous thromboses or potentially lethal pulmonary emboli. Transgendered individuals may remain unaware of the hematologic toxicity associated with hormone therapy. Besides VTE, they are also at risk of hypertriglyceridemia, hyperkalemia, hypertension, heart disease (including stroke), breast cancer, and permanent infertility (azoospermia). While estrogens offer the “magic” of feminization, they can also lead to morbidity.

Transgendered patients may choose to continue taking estradiol despite being aware of the VTE risk. Several factors complicate their decision-making process. Transgendered individuals often feel misunderstood and alienated when seeking medical care in the cisgender world. Those who are homeless within the trans community face additional economic and social challenges. While parenteral and transdermal forms of estradiol are reportedly safer, transgendered patients prefer the pill form due to its easy availability, enabling “do-it-yourself” care. A significant number of transgendered individuals lack insurance or have inadequate coverage. Even those with insurance may face continuous hurdles and rejections when seeking gender-affirming therapies. Financially constrained patients may resort to borrowing from friends or relying on “free” websites that offer low-cost or no-cost estrogens. Alternatively, they may purchase hormones from the gray market or drug vendors based in countries like Russia, Portugal, or Asia, where medication quality control is questionable. Quality assurance is sporadic at best, and some of the hormones sold online are outright counterfeits. Higher serum levels of estradiol do not necessarily correlate with increased feminization. Doubling or tripling the dose does not expedite the process but significantly raises the risk of VTE. The optimal dose for feminization remains unknown. In the absence of medical monitoring and knowledge, transgendered individuals continue their dangerous path of self-medication. Despite the threat of VTE, they resist changing their therapy due to the vasomotor symptoms (e.g., hot flashes), mood disturbances, and diminished quality of life that accompany cessation of estradiol.

It is the responsibility of physicians to educate transgendered patients about their medications. Through education, patients must make an informed decision, weighing the risk of clotting against the benefits of feminization. They must understand that their journey towards their identified gender can be perilous. Close monitoring by medical professionals could help prevent transgendered individuals from putting their lives at risk in their pursuit of beauty.

Robert Killeen is a hematologist.

Prev

A comic reveals the terrifying truth about fentanyl

July 27, 2023 Kevin 2
…
Next

When work becomes an escape for physicians [PODCAST]

July 27, 2023 Kevin 0
…

Tagged as: Oncology/Hematology

Post navigation

< Previous Post
A comic reveals the terrifying truth about fentanyl
Next Post >
When work becomes an escape for physicians [PODCAST]

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Robert Killeen, MD

  • Levamisole is good for your dog, but bad for your cocaine

    Robert Killeen, MD
  • How dementia and COVID-19 robbed the baby doll of love

    Robert Killeen, MD
  • a desk with keyboard and ipad with the kevinmd logo

    Hospice care for the transgendered patient

    Robert Killeen, MD

Related Posts

  • Hormone replacement therapy is still linked to cancer

    Martha Rosenberg
  • The health effects of structural racism

    Niran S. Al-Agba, MD
  • Cancer of the future: diagnosis, treatment, and impact on the health care system and patients

    Eugene Chan, MD
  • When breast cancer screening guidelines conflict: Some patients face real consequences

    Leda Dederich
  • Caught in the middle: How health insurance companies influence cancer drug selection

    Paul Pender, MD
  • The hidden benefits of your health insurance plan can save your life

    Michael L. Millenson

More in Conditions

  • How robotics are reshaping the future of vascular procedures

    David Fischel
  • How the shingles vaccine could help prevent dementia

    Marc Arginteanu, MD
  • Why removing fluoride from water is a public health disaster

    Steven J. Katz, DDS
  • What the research really says about infrared saunas

    Khushali Jhaveri, MD
  • How the cycle of rage is affecting physicians—and how to break free

    Alexandra M.P. Brito, MD and Jennifer L. Hartwell, MD
  • Dedicated hypermobility clinics can transform patient care

    Katharina Schwan, MPH
  • Most Popular

  • Past Week

    • Why Medicaid cuts should alarm every doctor

      Ilan Shapiro, MD | Policy
    • When the diagnosis is personal: What my mother’s Alzheimer’s taught me about healing

      Pearl Jones, MD | Conditions
    • 2 hours to decide my future: How the SOAP residency match traps future doctors

      Nicolette V. S. Sewall, MD, MPH | Education
    • Key strategies for smooth EHR transitions in health care

      Sandra Johnson | Tech
    • Reassessing the impact of CDC’s opioid guidelines on chronic pain care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • “Think twice, heal once”: Why medical decision-making needs a second opinion from your slower brain (and AI)

      Harvey Castro, MD, MBA | Tech
    • Why we fear being forgotten more than death itself

      Patrick Hudson, MD | Physician
    • Bureaucracy over care: How the U.S. health care system lost its way

      Kayvan Haddadan, MD | Physician
  • Recent Posts

    • How robotics are reshaping the future of vascular procedures

      David Fischel | Conditions
    • Medicalizing burnout misses the real problem

      Jessie Mahoney, MD | Physician
    • How the shingles vaccine could help prevent dementia

      Marc Arginteanu, MD | Conditions
    • How to survive a broken health care system without losing yourself [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why some doctors age gracefully—and others grow bitter

      Patrick Hudson, MD | Physician
    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 4 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why Medicaid cuts should alarm every doctor

      Ilan Shapiro, MD | Policy
    • When the diagnosis is personal: What my mother’s Alzheimer’s taught me about healing

      Pearl Jones, MD | Conditions
    • 2 hours to decide my future: How the SOAP residency match traps future doctors

      Nicolette V. S. Sewall, MD, MPH | Education
    • Key strategies for smooth EHR transitions in health care

      Sandra Johnson | Tech
    • Reassessing the impact of CDC’s opioid guidelines on chronic pain care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • “Think twice, heal once”: Why medical decision-making needs a second opinion from your slower brain (and AI)

      Harvey Castro, MD, MBA | Tech
    • Why we fear being forgotten more than death itself

      Patrick Hudson, MD | Physician
    • Bureaucracy over care: How the U.S. health care system lost its way

      Kayvan Haddadan, MD | Physician
  • Recent Posts

    • How robotics are reshaping the future of vascular procedures

      David Fischel | Conditions
    • Medicalizing burnout misses the real problem

      Jessie Mahoney, MD | Physician
    • How the shingles vaccine could help prevent dementia

      Marc Arginteanu, MD | Conditions
    • How to survive a broken health care system without losing yourself [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why some doctors age gracefully—and others grow bitter

      Patrick Hudson, MD | Physician
    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Transgender health risks in hormone therapy
4 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...