The impact of gender-affirming hormone therapy (GAHT) on anesthetic practices is crucial due to the cardiovascular and thrombotic risks from estrogen and testosterone-induced physiological changes. While the effects of
estrogen therapy in transgender females have been studied, showing a greater than fourfold increase in venous
thromboembolism (VTE) risk, this review focuses on testosterone therapy for transgender males and how it compares to estrogen therapy. This literature review examines the VTE risk associated with testosterone-based GAHT
in transgender males, comparing it to the known risks of estrogen therapy. A broad range of studies published within
the last 10 years were reviewed, analyzing data on the incidence of VTE and cardiovascular events in patients undergoing testosterone therapy. The findings indicate that testosterone therapy in transgender males presents a much
lower VTE risk compared to estrogen therapy, with a risk level comparable to those on testosterone therapy for hypogonadism. However, individualized risk assessment is crucial, highlighting the need for tailored anesthetic protocols to optimize patient safety. Limitations of this review include variability in study designs and the need for more
longitudinal data. This work advances the understanding of GAHT’s impact on anesthetic practices by providing a
comprehensive overview of current evidence, filling an important gap in transgender healthcare. This knowledge
is crucial for developing safe and effective anesthetic protocols that accommodate the unique needs of transgender
patients, ultimately improving surgical outcomes and patient care. Further research should be conducted on cardiovascular stability, as testosterone therapy presents a lower VTE risk for transgender males compared to estrogen
therapy for transgender females; however, testosterone has the potential to increase low-density lipoprotein (LDL)
and triglycerides, contributing to cardiovascular disease.
