Use sex hormones with an appropriate prescription and follow-up; do not adjust doses from internet posts
This entry concerns how to use hormones safely, not whether someone should use them. A cohort of transgender women showed higher rates of venous blood clots than matched cisgender controls, with about four additional cases per 1,000 people at two years and 17 at eight years compared with cisgender men. Clinical follow-up helps manage individual risks. Unverified products and unsupervised dosing bypass that care.
What it takes
Regular consultations and blood tests. The source estimates several hundred RMB annually and several half-days in China, though actual costs and monitoring depend on treatment.
What you may gain
Researchers followed 2,842 transgender women and 2,118 transgender men in Kaiser Permanente electronic health records for an average of 4.0 and 3.6 years, respectively. Participants were matched by birth year, race, site, and enrollment date to approximately ten times as many cisgender controls, totaling 48,686 cisgender men and 48,775 cisgender women. Among transgender women, excess venous thromboembolism risk compared with cisgender men was 4.1 per 1,000 at two years, 95% CI 1.6–6.7, and 16.7 per 1,000 at eight years, 95% CI 6.4–27.5. Compared with cisgender women, the corresponding differences were 3.4, 95% CI 1.1–5.6, and 13.7, 95% CI 4.1–22.7. Overall ischemic stroke and myocardial infarction incidence was similar across groups, but venous thrombosis and ischemic stroke differences were more pronounced among transgender women who initiated hormones during follow-up. Evidence for transgender men was insufficient for a firm conclusion. The authors suggested the findings might support long-term vigilance for estrogen-related vascular adverse effects.
Context & considerations
The authors could not fully identify hormone use obtained outside the health system, limiting exposure classification. This study examined vascular events; it does not answer whether hormone treatment should be used or measure its benefits, which require other evidence. Prescribing and monitoring also matter for contraception, menopausal hormone therapy, and testosterone treatment, though this cohort does not establish identical risks for those uses. The source warns against unsupervised online purchases, internet-guided dose changes, and absent follow-up for vascular risks and liver or kidney health. The exact monitoring should be chosen for the treatment, rather than assuming routine testing can rule out future clots. In China, seek an appropriate specialist or endocrinology service for assessment, prescribing, and follow-up.
Research & references
Getahun D et al. (2018). Cross-sex Hormones and Acute Cardiovascular Events in Transgender Persons: A Cohort Study. Annals of Internal Medicine. https://doi.org/10.7326/M17-2785; State Administration for Market Regulation (2022). Measures for Supervision of Online Drug Sales, Order No. 58, Article 9. https://www.gov.cn/gongbao/content/2022/content_5717002.htm