Terapia Hormonal Transfeminina

A fines de la década de 1990:

Los informes mostraron un aumento de hasta 20 veces en el TEV con etinilestradiol oral y esto condujo al cese del uso de esta medicación en este contexto287.

Desde entonces, el estradiol se ha convertido en el estrógeno preferido para el tratamiento transfeminino. El efecto hipercoagulable del estrógeno puede ser uno de los mediadores de mayor riesgo de ECV en mujeres transgénero295. El estradiol transdérmico, por lo tanto, se prefiere en mujeres transgénero mayores de 40 a 50 años para evitar el aumento del riesgo de un estado protrombótico por ingesta oral296.

Sin embargo, el riesgo de TEV en mujeres transgénero es diferente en comparación a mujeres cisgénero en las que este riesgo está presente principalmente en el primer año de uso y luego se reduce con el tiempo141. Por el contrario, el riesgo de TEV en mujeres transgénero aumenta con el tiempo, con un período de 2 y 8 años de riesgo de 4,1 (IC del 95%: 1,6 a 6,7) y 16,7 (IC del 95%: 6,4 a 27,5) por 1000 personas años, respectivamente, en comparación con la población de referencia de hombres (3,4 [95% CI 1,1-5,6]) y mujeres (13,7 [95% CI 4,1-22,7])293.

El tratamiento concomitante de mujeres transgénero con agentes hipoandrogénicos (por ejemplo, espironolactona o acetato de ciproterona) permite la administración de dosis más bajas de estrógeno exógeno285,297.

Las mujeres transgénero que reciben terapia hormonal no tienen mayor riesgo de infarto de miocardio:

Pero tienen mayor riesgo de accidente cerebrovascular (127 por 100 000 años persona) y TEV (320 por 100 000 años-persona). Esto es respectivamente un 80% más alto y un 355% más alto que en hombres cisgénero293. Además, el uso concomitante de tabaco y otros factores de estilo de vida en las personas transgénero están presentes de manera desproporcionada298. El accidente cerebrovascular isquémico parece más pronunciado después de 6 años de uso continuo de estrógenos y continúa aumentando a partir de entonces.

El cese de las hormonas del sexo cruzado no es una opción para las personas transgénero. Por lo tanto, siempre se les debe animar a reducir riesgos de estilo de vida modificables. Los beneficios psicosociales de la terapia hormonal con una imagen corporal mejorada pueden resultar en opciones de estilo de vida más saludable .

Puntos prácticos

• Las personas transgénero tienen un mayor riesgo de sufrir enfermedades cardiovasculares.
• El riesgo de TEV en mujeres transgénero aumenta con el tiempo.
• Se prefieren los estrógenos transdérmicos al tratamiento oral.

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