Senior Author:  John Henry Pang, MD, Assistant Professor of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai and Center for Transgender Medicine and Surgery

First Author:  Aki Kozato BS, Medical Student, Icahn School of Medicine at Mount Sinai

Bottom Line: This study found that transgender women can maintain their hormone treatments during gender affirming surgery.

What: This is the first study to demonstrate that there is no difference in blood clots when transgender women remain on estrogen hormone therapy for gender affirming surgery. Because both estrogen therapy and surgery can increase a person’s risk of blood clots, experts had long suggested that transgender women stop taking estrogen when undergoing gender affirming surgery. However, there was previously no published data on the blood clot risk specific to transgender women undergoing surgery.

Why Is the Study Important: Historically, the lack of published data contributed to heterogeneity in the practice of whether doctors and surgeons advised transgender women to withhold their estrogen therapy before surgery. The sudden loss of estrogen in the blood was sometimes very uncomfortable with symptoms that amounted to a sudden, severe menopause.

This novel study found that the practice of withholding estrogen prior to gender affirming surgery was not necessary. Most transgender women can now safely remain on their estrogen therapy throughout surgery.

Who: This is a study of 919 transgender patients who underwent gender affirming surgery at Mount Sinai’s Center for Transgender Medicine and Surgery between November 2015 and August 2019. Notably, it includes 407 cases of transgender women who underwent primary vaginoplasty surgery.

Conclusions:  Results indicated that there was no difference in blood clots when estrogen hormone therapy was maintained during gender affirming surgery. Because of Mount Sinai’s aggressive blood clot prevention practice, only one blood clot occurred during the entire period reviewed, in a patient who had stopped her estrogen for the surgery.

Said Dr. Pang about the Study:  “As one the largest comprehensive transgender programs, we at Mount Sinai consider it our responsibility to use our position to improve care for our patients.  We were the first to present our findings to an international audience that estrogen use may be safe to continue during surgery.  Our new published data should be exciting news for our patients.”

Paper Title:  No Venous Thromboembolism Increase Among Transgender Female Patients Remaining on Estrogen for Gender Affirming Surgery

Journal: Journal of Clinical Endocrinology & Metabolism