Evaluating the risk of venous thromboembolism in transfeminine and gender diverse people: A retrospective analysis.

Teaching Points:•Venous thromboembolism (VTE) is an uncommon event in transgender and gender-diverse individuals, with a prevalence that may be even lower than previously believed.•VTE is associated with older age, potential surrogate measures for social determinants of health, and cardiometabolic comorbid conditions, highlighting the concept that one's risk of VTE is driven by a complex multitude of medical and non-medical factors, often occurring in tandem.•Feminizing gender-affirming hormone therapy using exogenous estrogen may not be independently associated with an increased risk of VTE but should be an indicator to look for other factors that may heighten one's risk.AbstractObjectiveThe risk of venous thromboembolism (VTE) with feminizing gender-affirming hormone therapy (GAHT) is an area of concern. This analysis aimed to assess whether GAHT and other potential risk factors are associated with VTE in transfeminine and gender diverse (TGD) individuals.MethodsWe conducted a chart review of 2,126 TGD adults receiving care within a large urban health system. The primary outcomes were the prevalence of VTE and odds ratios for the association of VTE with insurer, use of estrogen, and select comorbidities.ResultsA history of VTE was documented in 0.8% of the cohort. Those with a history of VTE were older (p<.001), more often self-identified as Hispanic or Black compared to white or Asian (p<.05) and were more likely to have Medicaid or Medicare (p<.01) when compared to those without a history of VTE. The prevalence of hyperlipidemia (p<.001), diabetes mellitus (p<.05), and hypercoagulable conditions (p<.001) were all greater in the +VTE group. Hyperlipidemia (p<.001), diabetes mellitus (p<.05), and insurer (p<.05) were associated with increased odds of VTE in univariate analyses. None of the exposure variables analyzed were associated with VTE when controlling for age, race, and the number of comorbidities.ConclusionsThe prevalence of VTE in our cohort was lower than previously observed. VTE was not associated with any one risk factor, including estrogen use, when controlling for age, race, and the number of comorbidities. Those of advanced age and those with multiple cardiometabolic comorbidities may benefit from increased surveillance and mitigation of modifiable risk factors.