使用激素的跨性别女性血栓发生率是男性的4.5倍且中风更多；跨性别男性心脏病发作多于女性

接受激素治疗的跨性别者急性心血管事件的发生情况

Authors: Nienke M. Nota, Chantal M. Wiepjes, Christel J.M. de Blok, Louis J.G. Gooren, Baudewijntje P.C. Kreukels, Martin den Heijer
Journal: Circulation
Year: 2019
Source: https://doi.org/10.1161/CIRCULATIONAHA.118.038584

Summary

This short report used records from the Amsterdam gender clinic, which treats most trans people in the Netherlands. It counted strokes, heart attacks and blood clots in nearly 3,900 people on cross-sex hormones over about 8 to 9 years, and compared them with expected rates in the general population. Trans women had about 4.5 to 5.5 times the expected rate of blood clots and about twice the expected rate of stroke, and more heart attacks than women (but not men). Trans men had more heart attacks than women but about the same as men. Blood-clot risk was lower, though still raised, in trans women who started after 2001, when an older estrogen was dropped. The long follow-up makes this useful, but the comparison is with outside population figures, smoking was not accounted for, and the trans men's results rest on few events.

Key findings

该研究纳入了在阿姆斯特丹性别诊所接受治疗的2,517名跨性别女性和1,358名跨性别男性，平均分别随访约9年和8年。
跨性别女性有73例静脉血栓：是女性预期比率的5.5倍，男性的4.5倍。
跨性别女性有29例中风（是女性比率的2.4倍，男性的1.8倍）和30例心脏病发作（是女性比率的2.6倍；与男性相比没有更高）。
跨性别男性有11例心脏病发作：是女性预期比率的3.7倍，与男性预期相同。
跨性别男性只有6例中风和2例血栓，与男性或女性相比没有明显差异。
排除2001年之前（当时较旧的雌激素乙炔雌二醇被取代）开始的跨性别女性后，血栓率降至女性的约3.9倍和男性的3.4倍；其他风险没有下降。
研究中43%至46%的人吸烟，这一点无法加以考虑。

Conclusion

Considering the limitations, the authors conclude that the incidences of strokes and VTEs are higher in transwomen receiving hormone therapy than in both reference women and men, and that transwomen and transmen receiving hormone therapy are at higher risk of myocardial infarction than reference women. They urge physicians and transgender individuals to be aware of this increased cardiovascular risk and to reduce risk factors such as smoking.

Methodological limitations

Very short report: It was published as a two-page letter with few details, so how events were defined, who was left out and how results were checked are only briefly described.
Outside comparison only: Rates were compared with figures from separate Dutch and Norwegian population studies that found cases in different ways, not with a matched group of similar people.
Other risk factors ignored: The authors could not account for smoking (43–46% smoked) or life stresses, and weight, diabetes and other risk factors were not accounted for either.
Events may have been missed: Events were found by searching clinic files for doctors' letters. Events treated elsewhere and not reported back may have been missed, so true rates are probably higher.
Older drugs: Much of the follow-up involved older drugs (ethinylestradiol and high-dose cyproterone). Leaving out early starters lowered blood-clot risk, so the headline figure overstates risk on today's drugs, though risk was still raised.
Few events in trans men: Results rest on 6 strokes, 11 heart attacks and 2 blood clots, so the figures are very uncertain.
Some people left out: People who stopped hormones for long periods or switched between male and female hormones (such as some detransitioners) were excluded, as were 52 people with a past event.
Uneven follow-up: The typical person was followed for only about 4 to 6 years, much less than the average, so much of the data comes from a minority treated for a long time.
One clinic: Everyone was treated at one specialist centre, so results may not apply outside the Netherlands.

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Summary

Key findings

Conclusion