使用荷爾蒙的跨性別女性血栓發生率是男性的4.5倍且中風更多；跨性別男性心臟病發作多於女性

接受荷爾蒙治療的跨性別者急性心血管事件的發生情況

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

研究納入在阿姆斯特丹性別門診接受治療的 2,517 名跨性別女性和 1,358 名跨性別男性，平均分別追蹤約 9 年和 8 年。
跨性別女性有 73 例靜脈血栓：為女性預期比率的 5.5 倍，男性的 4.5 倍。
跨性別女性有 29 例中風（女性比率的 2.4 倍，男性的 1.8 倍）和 30 例心臟病發作（女性比率的 2.6 倍；沒有比男性高）。
跨性別男性有 11 例心臟病發作：為女性預期比率的 3.7 倍，與男性預期相同。
跨性別男性只有 6 例中風和 2 例血栓，與男性或女性都沒有明顯差異。
排除 2001 年以前（當時較舊的雌激素 ethinylestradiol 被取代）開始的跨性別女性後，血栓率降至女性的約 3.9 倍和男性的 3.4 倍；其他風險並沒有下降。
研究中 43–46% 的人吸菸，而這點無法被考慮。

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.

detrans.ai

Summary

Key findings

Conclusion