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- Title
Global Coagulation Assays in Transgender Women on Oral and Transdermal Estradiol Therapy.
- Authors
Hui Yin Lim; Leemaqz, Shalem Y.; Niloufar Torkamani; Grossmann, Mathis; Zajac, Jeffrey D.; Nandurkar, Harshal; Ho, Prahlad; Cheung, Ada S.; Lim, Hui Yin; Torkamani, Niloufar
- Abstract
<bold>Context: </bold>The thrombotic effects of estradiol therapy in transgender women are unclear. Global coagulation assays (GCA) may be better measures of hemostatic function compared with standard coagulation tests.<bold>Objective: </bold>To assess the GCA profiles of transgender women in comparison to cisgender controls and to compare how GCA differ between routes of estradiol therapy in transgender women.<bold>Design: </bold>Cross-sectional case-control study.<bold>Setting: </bold>General community.<bold>Participants: </bold>Transgender women, cisgender male and cisgender female controls.<bold>Main Outcome Measures: </bold>Citrated blood samples were analyzed for (i) whole blood thromboelastography (TEG®5000), (ii) platelet-poor plasma thrombin generation (calibrated automated thrombogram); and (iii) platelet-poor plasma fibrin generation (overall hemostatic potential assay). Mean difference (95% confidence intervals) between groups are presented.<bold>Results: </bold>Twenty-six transgender women (16 oral estradiol, 10 transdermal estradiol) were compared with 98 cisgender women and 55 cisgender men. There were no differences in serum estradiol concentration (P = 0.929) and duration of therapy (P = 0.496) between formulations. Transgender women demonstrated hypercoagulable parameters on both thromboelastography (maximum amplitude + 6.94 mm (3.55, 10.33); P < 0.001) and thrombin generation (endogenous thrombin potential + 192.62 nM.min (38.33, 326.91); P = 0.009; peak thrombin + 38.10 nM (2.27, 73.94); P = 0.034) but had increased overall fibrinolytic potential (+4.89% (0.52, 9.25); P = 0.024) compared with cisgender men. No significant changes were observed relative to cisgender women. Route of estradiol delivery or duration of use did not influence the GCA parameters.<bold>Conclusion: </bold>Transgender women on estradiol therapy demonstrated hypercoagulable GCA parameters compared with cisgender men with a shift towards cisgender female parameters. Route of estradiol delivery did not influence the GCA parameters.
- Subjects
TRANS women; ESTRADIOL; BLOOD coagulation factors; BLOOD coagulation; MEDICAL personnel; ETHINYL estradiol; FIBRIN; THERAPEUTICS; RESEARCH; BLOOD coagulation tests; HORMONES; ORAL drug administration; CROSS-sectional method; RESEARCH methodology; CASE-control method; TRANSDERMAL medication; THROMBELASTOGRAPHY; EVALUATION research; MEDICAL cooperation; DRUG administration; COMPARATIVE studies; THROMBIN
- Publication
Journal of Clinical Endocrinology & Metabolism, 2020, Vol 105, Issue 7, p1
- ISSN
0021-972X
- Publication type
journal article
- DOI
10.1210/clinem/dgaa262