PB0439 - Longitudinal thrombo-inflammatory profiling of individuals undergoing gender-affirming hormone therapy

Sunday, June 23, 2024

13:45 – 14:45 ICT

Room: Exhibition Hall

Presenting Author(s)

Elena Campello, PhD

Assistant Professor
General Internal Medicine Unit and Thrombotic and Hemorrhagic Disease Unit, Department of Medicine, Padova University Hospital, Padova, Italy
Padova, Veneto, Italy

Co-Author(s)

AS

Alberto Scala

MD
Unit of Andrology and Reproductive Medicine, Department of Medicine (DIMED), University of Padova, Padova, Italy.
Padova, Veneto, Italy
CS

Chiara Simion

PhD Student in Hematological and Geriatric Sciences
University of Padua, Department of Medicine -DIMED
Padova, Veneto, Italy
CB

Cristiana Bulato

PhD
General Internal Medicine Unit and Thrombotic and Hemorrhagic Disease Unit, Department of Medicine, Padova University Hospital, Padova, Italy
Padova, Veneto, Italy
SG

Sabrina Gavasso

Lab Technician
General Internal Medicine Unit and Thrombotic and Hemorrhagic Disease Unit, Department of Medicine, Padova University Hospital, Padova, Italy
Padova, Veneto, Italy
ST

Serena Toffanin

PhD student
Università di Padova
Padova, Veneto, Italy
GF

Giacomo Faggian

Student
Unit of Andrology and Reproductive Medicine, Department of Medicine (DIMED), University of Padova, Padova, Italy.
Padova, Veneto, Italy
GN

Giorgia Nuozzi

Post-doc
General Internal Medicine Unit and Thrombotic and Hemorrhagic Disease Unit, Department of Medicine, Padova University Hospital, Padova, Italy
Padova, Veneto, Italy
AG

Andrea Garolla

Prof
Unit of Andrology and Reproductive Medicine, Department of Medicine (DIMED), University of Padova, Italy.
Padova, Veneto, Italy
Paolo Simioni, MD, PhD

Head of Department of Medicine
University of Padova, Padova University Hospital
Padova, Veneto, Italy

Background: Transgender individuals appear to carry an increased risk of venous and arterial thrombosis related to the hypercoagulability driven by gender-affirming hormone therapy (GAHT). The mechanisms underpinning these harmful relationships are not known.

Aims: To investigate the effects of GAHT on coagulation and erythropoiesis, exploring the mechanisms underlying the hypercoagulability in transgender population.

Methods: Adult transgender subjects who initiated GAHT at the University Hospital of Padova between December 2022 and September 2023 underwent plasma venous samples at baseline (before the start of GAHT) and 3 and 6 months after starting GAHT to assess complete blood count, levels of sex hormones, presence of hereditary thrombophilia, procoagulant factor VIII and fibrinogen, protein C, protein S, antithrombin, thromboelastometry, whole blood aggregometry, and iron metabolism. Non-parametric Wilcoxon test for paired data was used to evaluate longitudinal changes of these parameters during follow-up.

Results: Sixty-nine transgender subjects, of whom 26 Assigned Male At Birth [AMAB] and 43 Assigned Feminine At Birth [AFAB] who initiated GAHT were enrolled (Table 1). As for AMAB, a significant increase in platelet count, protein S activity and TRAP (Thrombin Receptor-Activating Protein) aggregometry was detected 3 and 6 months after starting GAHT. Additionally, A significant shortening of CFT-INTEM (clotting formation time) was observed at 6 months (Table 2). As for AFAB, a significant increase of hemoglobin, hematocrit and iron with a decrease of ferritin and transferrin saturation were detected. Interestingly, a significant prolongation of CFT-EXTEM with decrease of MCF in INTEM, EXTEM and FIBTEM were observed at thromboelastometry (Table 2). No significant correlations were found between sex hormones and coagulation parameters.

Conclusion(s): This longitudinal analysis reveals early changes in thrombo-inflammatory parameters in subjects undergoing 6-month GAHT. Namely, AMAB appear to have increase platelet count and thrombin-driven aggregability, while the main changes for AFAB pertain to iron metabolism and erythrocytosis.