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Type: Journal article
Title: Global coagulation assays in transgender women on oral and transdermal estradiol therapy
Author: Lim, H.Y.
Leemaqz, S.Y.
Torkamani, N.
Grossmann, M.
Zajac, J.D.
Nandurkar, H.
Ho, P.
Cheung, A.S.
Citation: Journal of Clinical Endocrinology and Metabolism, 2020; 105(7):e2369-e2377
Publisher: Oxford University Press
Issue Date: 2020
ISSN: 0021-972X
Statement of
Hui Yin Lim, Shalem Y. Leemaqz, Niloufar Torkamani, Mathis Grossmann, Jeffrey D. Zajac, Harshal Nandurkar, Prahlad Ho, and Ada S. Cheung
Abstract: Context: 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. Objective: 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. Design: Cross-sectional case-control study. Setting: General community. Participants: Transgender women, cisgender male and cisgender female controls. Main Outcome Measures: 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. Results: 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. Conclusion: 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.
Keywords: Global coagulation assays; coagulation; estrogen; thrombosis; transgender
Rights: © Endocrine Society 2020. All rights reserved. For permissions, please e-mail:
DOI: 10.1210/clinem/dgaa262
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