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What is the Consensus: Cessation or Continuation of Hormone Replacement Therapy Prior to Transgender "Top Surgery"?
Maslowski D, Snyder S, Ueno CM
West Virginia University
2020-01-31
Presenter: Doug Maslowski
Affidavit:
I certify that this project has not been presented or published in any other settings. This work is the original work of Doug M and Sean S with the assistance of Dr. Ueno for the project idea.
Director Name: Dr. Kerri Woodberry
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Introduction:
There are over 1 million transgender individuals in the U.S. ASPS data between 2016 to 2017 showed gender confirmation surgery (GCS) increased by 155%. In transmen, testosterone increases risks of polycythemia vera and worsens their lipid profile. In transwomen, oral estrogen increases risks of cardiovascular disease, mainly venous thromboembolic events (VTE). Today, many surgeons suspend hormone therapy (HT) prior to surgery to theoretically reduce the risk of VTE's.
Objective:
Primarily, evaluate the risk of VTE in transgender patients undergoing breast transmasculine or transfeminine surgery ("top surgery"). Secondarily, establish if surgeons should stop HT prior to surgery.
Methods:
PubMed search terms such as transgender surgery, venous thromboembolic events, breast transmasculine, breast transfeminine surgery, top surgery and similar terms were used to perform a literature review.
Discussion:
Literature review showed variable results with potential increases in VTE in transfemales on estrogen therapy and no significant increased risk with testosterone therapy. Currently, there is a lack of large research studies investigating VTE risk in those who suspend HT vs those who continue HT. Recent studies suggest insufficient evidence at this time to determine if continuation or cessation of HRT is indicated prior to surgery. Our institution has limited data but doesn't show increased risk of VTE related to HT in GCS top surgery.
Conclusion:
Continue to compile data involving transgender patients that maintain HT during surgery and risks of VTE. Additionally, compare cis-gender patients undergoing breast surgery who continue their oral contraceptives with transgender patients undergoing top surgery.
