By: Plume Community Member
When you are getting ready to start estrogen as a gender-affirming medication, you may wonder whether there are any possible risks. Gender-affirming hormone therapy (GAHT, sometimes also called HRT or hormone replacement therapy) is safe and used to help all types of transgender, nonbinary, genderfluid, intersex, and other people align with their gender identities. The medication that is taken when someone starts estrogen is called “estradiol.” This article discusses the specific risks of estradiol or estrogen as they relate to blood clots and heart disease.
When used appropriately under supervision of a medical provider, estradiol has been shown to be safe. Of course, every medication has its risks and it is important to understand these risks so that you can make an informed decision about your care. We will discuss some of the risks in this article. If you are a Plume Member and you are getting ready to start estrogen, be sure to review the informed consent form. This form is sent to you through our secure app prior to your first appointment. If you have any worries or concerns, you can discuss them (and any questions about your medications) with your Care Team.
At Plume, we prescribe estradiol, a form of estrogen that does have a lower risk of blood clots than other forms of estrogen (like premarin, or ethinyl estradiol – the estrogen used in birth control pills). Studies do show a link between higher blood levels of estradiol and large dose increases, and more blood clots. So far, we do not have evidence that higher levels of estradiol correlate with different levels of physical change. That is why we try to keep estradiol levels between 50-200 and ask patients to get blood work done every 3-4 months while taking their medications.
Several review studies looking back over the past 30-40 years have shown trends that estrogen might lead to more blood clots, strokes, or heart attacks relative to the general population. The majority of studies are not focused on estrogen use for trans folks, so they do not differentiate between the many types of estrogen medication being used. They also don’t fully account for many other risk factors like smoking, pre-existing heart disease, and other medical problems.
The bottom line is that there might be a small increased risk of blood clot, stroke, and/or heart attack when taking estrogen, however this risk is lowered by using bioidentical estradiol and regular lab monitoring. The risk also depends on your underlying health, your smoking status, and, perhaps, the type of estrogen you take (there is some evidence that patches, and maybe injections, may provide a lower risk of clots than the pill). You can talk to your Care Team about your specific risk.
Taking estrogen as part of gender-affirming hormone therapy is a big decision and one that is an exciting milestone in your gender transition. It is important to understand the potential risks and benefits of taking estrogen before you start the process. At Plume, we understand that taking estrogen or any gender-affirming hormone medication is a personal decision, and we strive to provide the best care possible. We provide access to medications and resources that can help you understand the potential risks and benefits of taking estrogen. We also provide access to experts who can provide education and support throughout the process.
Learn more about your options and start your customized care plan with Plume today!
