Abstract Number: PB2225
Meeting: ISTH 2020 Congress
Theme: Venous Thromboembolism and Cardioembolism » Thrombophilia
Background: Doing the thrombophilia test prior to the start of hormonal therapy in patients with “male to female” gender dysphoria is quite accepted because the history of venous thromboembolic disease (VTE) and the existence of thrombophilia contraindicates the initiation of estrogenic treatment. On the other hand, in patients with “female to male” gender dysphoria who are going to receive treatment with testoterone it is controversial since there is no evidence that links it to an increased thrombotic risk.
Aims: To describe our experience in the clinical management of patients with gender dysphoria with thrombophilia.
Methods: During 2018 and 2019, a total of 27 studies of thrombophilia were carried out in our center in people with gender dysphoria, the results and attitude adopted according to it were analyzed.
Results: 70.37% (19 patients) had a negative study, with 29.63% (8 patients) presenting a positive test. Of these 8 patients, 3 were “female to male” and were going to receive testosterone therapy. The characteristics of these patients are shown in Table 1.The remaining patients (5) were to receive estrogen therapy. The characteristics of these patients are summarized in Table 2.
None of the patients who received hormone therapy suffered VTE.
Conclusions: Doing the thrombophilia test prior to the start of estrogenic hormonal treatment is necessary since it determines the clinical attitude. When reporting the risk of VTE that is conferred by estrogenic hormonal treatment in patients with thrombophilia, sometimes they decline to receive such treatment. In patients who did receive it, anticoagulation was chosen to minimize the risk of VTE.
More studies are needed to define the role of the thrombophilia study in patients who are going to require testosterone therapy since there is no clear evidence that links it to VTE and therefore the indication of anticoagulation / antiplatelet therapy is much discussed.
| Thrombophilia | Anticoagulation / antiplatelet therapy |
| Factor II mutation | No |
| Lupus anticoagulant positive | No |
| Factor V Leiden mutation | Aspirin |
[Table 1]
| Thrombophilia | Anticoagulant /antiplatelet therapy |
| Lupus anticoagulant positive and anticardiolipin antibody IgM positive | Sintrom |
| Factor II mutation | Estrogen treatment not performed |
| Protein C and S deficit | Sintrom |
| Lupus anticoagulant positive | No |
| Protein S treatment | Estrogen treatment not performed |
[Table 2]
To cite this abstract in AMA style:
Díaz Roldán B, Domínguez Rodríguez JF, Carranco Falcón AR. Positive Thrombophilia Study in the Context of Starting Hormonal Treatment in the Gender Dysphory: Experience in a Single Center [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/positive-thrombophilia-study-in-the-context-of-starting-hormonal-treatment-in-the-gender-dysphory-experience-in-a-single-center/. Accessed September 24, 2023.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/positive-thrombophilia-study-in-the-context-of-starting-hormonal-treatment-in-the-gender-dysphory-experience-in-a-single-center/