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Should Exogenous Estrogens Be Stopped for Surgery in Transgender Women?

BACKGROUND There are an estimated 700,000 to 1 million transgender individuals living in the United States alone. Although these individuals require the same, if not greater, level of surgical care due to the importance of gender-affirming surgery, they often require medical treatment involving cross-sex hormone therapy or medications, which block the effects of endogenous hormones. For transfeminine (male-to-female transgender) individuals, patients are typically counseled to hold medications such as exogenous estrogens due to the concern of increased risk of venous thromboembolism (VTE). This practice is not without risks as stopping treatment can increase dysphoria and lead to symptoms such as hot flashes and mood disruption. Indeed, recent studies have brought to light controversies regarding the appropriateness of stopping medical therapy. This review aims to answer whether or not exogenous estrogens should be stopped prior to surgery in male-to-female transgender individuals.