CitationsRisk Reduction for DIY Gender-Affirming Hormone Therapy(last updated 5/21/2025)The citations on this page are mostly from academic sources. We have provided links to these, but many of the articles we cite may be pay-walled. Your academic or public library may have direct access to these articles, or may be able to obtain them through Inter Library Loan. Finally, the corresponding authors of academic papers are often willing to respond favorably to a polite email request for a copy of their published article. 1. Finding the right dose, and problems with high doses 2. Blood clot risks from smoking tobacco and vaping nicotine 3. Blood clots and combining smoking tobacco or vaping nicotine with gender-affirming estrogen 4. Blood clots and gender-affirming estrogen 5. Signs of blood clotting and stroke 6. 17β-estradiol (especially as a patch) and lowest risk for blood clots 7. Ethinyl estradiol (oral contraceptives) and higher risk for blood clots 8. Injectable estradiol higher in blood levels shortly after injection 17. Feminizing hormones and fertility & pregnancy prevention 19. Blood thickening and gender-affirming testosterone 20. Cholesterol and gender-affirming testosterone 21. Masculinizing hormones and fertility & pregnancy prevention
Canonico, M., et al. (2008). Hormone replacement therapy and risk of venous thromboembolism in postmenopausal women: systematic review and meta-analysis. British Medical Journal, 336(7655), 1227–1231. de Bastos, M., et al. (2014). Combined oral contraceptives: venous thrombosis. Cochrane Database of Systematic Reviews. Misakian, A. L., at al. (2025), Injectable Estradiol Use in Transgender and Gender-Diverse Individuals throughout the United States. The Journal of Clinical Endocrinology & Metabolism, Online first. Testosterone Side Effects: Common, Severe, Long Term. (2020). Drugs.com. Accessed: April 11, 2021. Ageno, W., et al. (2008). Cardiovascular Risk Factors and Venous Thromboembolism. Circulation, 117(1), 93–102. Burns, D. M. (2003). Epidemiology of smoking-induced cardiovascular disease. Progress in Cardiovascular Diseases, 46(1), 11–29. Cheng, Y.-J., et al. (2013). Current and former smoking and risk for venous thromboembolism: A systematic review and meta-analysis. PLoS Medicine, 10(9). Holst, A. G., Jensen, G., & Prescott, E. (2010). Risk Factors for Venous Thromboembolism. Circulation, 121(17), 1896–1903. Hom, S., et al. (2016). Platelet activation, adhesion, inflammation, and aggregation potential are altered in the presence of electronic cigarette extracts of variable nicotine concentrations. Platelets, 27(7), 694–702. Kannel, W. B. (2005). Overview of hemostatic factors involved in atherosclerotic cardiovascular disease. Lipids, 40(12), 1215–1220. Qasim, H., et al. (2017). Impact of Electronic Cigarettes on the Cardiovascular System. Journal of the American Heart Association, 6(9), 1–14. Ramirez, J. E., et al. (2020). The JUUL E-Cigarette Elevates the Risk of Thrombosis and Potentiates Platelet Activation. Journal of Cardiovascular Pharmacology and Therapeutics, 25(6), 578–586. Coleman, E., et al. (2012). Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7. International Journal of Transgenderism, 13(4), 165–232. Iwamoto, S. J., et al. (2019). Health considerations for transgender women and remaining unknowns: a narrative review. Therapeutic Advances in Endocrinology and Metabolism, 10, 1–27. Canonico, M., et al. (2008). Hormone replacement therapy and risk of venous thromboembolism in postmenopausal women: systematic review and meta-analysis. British Medical Journal, 336(7655), 1227–1231. Irwig, M. S. (2018). Cardiovascular health in transgender people. Reviews in Endocrine and Metabolic Disorders, 19(3), 243–251. Iwamoto, S. J., et al. (2019). Health considerations for transgender women and remaining unknowns: a narrative review. Therapeutic Advances in Endocrinology and Metabolism, 10, 1–27. Tangpricha, V., & Safer, J. D. (2019). Transgender women: Evaluation and management. (Requires subscription). uptodate.com. Accessed: March 8, 2021. Van Kesteren, P. J., et al. (1997). Mortality and morbidity in transsexual subjects treated with cross-sex hormones. Clinical Endocrinology, 47(3), 337–343. Weinand, J. D., & Safer, J. D. (2015). Hormone therapy in transgender adults is safe with provider supervision; A review of hormone therapy sequelae for transgender individuals. Journal of Clinical & Translational Endocrinology, 2(2), 55–60. American Heart Association. (2017). Symptoms and Diagnosis of Venous Thromboembolism (VTE). heart.org. Accessed: April 12, 2021. American Stroke Association. (2021). Stroke Symptoms. stroke.org. Accessed: April 12, 2021 National Blood Clot Alliance. (2020). Signs and Symptoms of Blood Clots. stoptheclot.org. Accessed: April 12, 2021 Asscheman, H., et al. (2013). Venous thrombo-embolism as a complication of cross-sex hormone treatment of male-to-female transsexual subjects: a review. Andrologia, 46(7), 791–795. Canonico, M., et al. (2008). Hormone replacement therapy and risk of venous thromboembolism in postmenopausal women: systematic review and meta-analysis. British Medical Journal, 336(7655), 1227–1231. Goldstein, Z., et al. (2019). Managing the risk of venous thromboembolism in transgender adults undergoing hormone therapy. Journal of Blood Medicine, 10, 209–216. Irwig, M. S. (2018). Cardiovascular health in transgender people. Reviews in Endocrine and Metabolic Disorders, 19(3), 243–251. Ott, J., et al. (2010). Incidence of thrombophilia and venous thrombosis in transsexuals under cross-sex hormone therapy. Fertility and Sterility, 93(4), 1267–1272. Renoux, C., et al. (2010). Transdermal and oral hormone replacement therapy and the risk of stroke: a nested case-control study. British Medical Journal, 340(jun03 4), c2519–c2519. Samsioe, G. (2004). Transdermal hormone therapy: gels and patches. Climacteric, 7(4), 347–356. Wilson, R., et al. (2009). Effects of high dose oestrogen therapy on circulating inflammatory markers. Maturitas, 62(3), 281–286. Asscheman, H., et al. (2011). A long-term follow-up study of mortality in transsexuals receiving treatment with cross-sex hormones. European Journal of Endocrinology, 164(4), 635–642. Asscheman, H., et al. (2013). Venous thrombo-embolism as a complication of cross-sex hormone treatment of male-to-female transsexual subjects: a review. Andrologia, 46(7), 791–795. de Bastos, M., et al. (2014). Combined oral contraceptives: venous thrombosis. Cochrane Database of Systematic Reviews, (3). Goldstein, Z., et al. (2019). Managing the risk of venous thromboembolism in transgender adults undergoing hormone therapy. Journal of Blood Medicine, 10, 209–216. Hembree, W. C., et al. (2017). Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society* Clinical Practice Guideline. The Journal of Clinical Endocrinology & Metabolism, 102(11), 3869–3903. Hugon-Rodin, J., Gompel, A., & Plu-Bureau, G. (2014). Epidemiology of hormonal contraceptives-related venous thromboembolism. European Journal of Endocrinology, 171(6), R221–R230. Toorians, A. W., et al. (2003). Venous Thrombosis and Changes of Hemostatic Variables during Cross-Sex Hormone Treatment in Transsexual People. The Journal of Clinical Endocrinology & Metabolism, 88(12), 5723–5729. Unger, C. A. (2016). Hormone therapy for transgender patients. Translational Andrology and Urology, 5(6), 877–884. Weiss, G. (1999). Risk of venous thromboembolism with third-generation oral contraceptives: A review. American Journal of Obstetrics and Gynecology, 180(2), S295–S301. Deutsch, M. (2020, July). Information on Estrogen Hormone Therapy. UCSF Transgender Care & Treatments and Guidelines. Accessed: April 12, 2021. Irwig, M. S. (2018). Cardiovascular health in transgender people. Reviews in Endocrine and Metabolic Disorders, 19(3), 243–251. Deutsch, M. (2020, July). Information on Estrogen Hormone Therapy. UCSF Transgender Care & Treatments and Guidelines. Accessed: April 12, 2021 American Society of Health-System Pharmacists. (2018). Spironolactone: Drug Information. MedlinePlus. Accessed: April 23, 2021. Deutsch, M. B. (Ed.). (2016, June 17). Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People. UCSF Transgender Care & Treatments and Guidelines. Accessed: April 12, 2021 Deutsch, M. (2020, July). Information on Estrogen Hormone Therapy. UCSF Transgender Care & Treatments and Guidelines. Accessed: April 12, 2021 Prior, J. C., Vigna, Y. M., & Watson, D. (1989). Spironolactone with physiological female steroids for presurgical therapy of male-to-female transsexualism. Archives of Sexual Behavior, 18(1), 49–57. American Society of Health-System Pharmacists. (2016). Eplerenone. MedlinePlus. Accessed: April 23, 2021. Craft, J. (2004). Eplerenone (Inspra), a New Aldosterone Antagonist for the Treatment of Systemic Hypertension and Heart Failure. Baylor University Medical Center Proceedings, 17(2), 217–220. American Society of Health-System Pharmacists. (2018). Finasteride. MedlinePlus. Accessed: April 23, 2021. Levine, D., & Terhune, C. (2021, February 3). Exclusive: Merck anti-baldness drug Propecia has long trail of suicide reports, records show. Reuters. American Society of Health-System Pharmacists. (2018). Bicalutamide. MedlinePlus. Accessed: April 23, 2021. Deutsch, M. (2020, July). Information on Estrogen Hormone Therapy. UCSF Transgender Care & Treatments and Guidelines. Accessed: April 12, 2021 Kolvenbag, G. J. C. M., & Blackledge, G. R. P. (1996). Worldwide activity and safety of bicalutamide: a summary review. Urology, 47(1), 70–79. Deutsch, M. B. (Ed.). (2016, June 17). Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People. UCSF Transgender Care & Treatments and Guidelines. Accessed: April 12, 2021 Deutsch, M. (2020, July). Information on Estrogen Hormone Therapy. UCSF Transgender Care & Treatments and Guidelines. Accessed: April 12, 2021 Prior, J. C. (2019). Progesterone is important for transgender women’s therapy—applying evidence for the benefits of progesterone in ciswomen. The Journal of Clinical Endocrinology & Metabolism, 104(4), 1181–1186. Practice Committee of the American Society for Reproductive Medicine. (2017). Combined hormonal contraception and the risk of venous thromboembolism: a guideline. Fertility and Sterility, 107(1), 43–51. de Bastos, M., et al. (2014). Combined oral contraceptives: venous thrombosis. Cochrane Database of Systematic Reviews, (3). Practice Committee of the American Society for Reproductive Medicine. (2017). Combined hormonal contraception and the risk of venous thromboembolism: a guideline. Fertility and Sterility, 107(1), 43–51. de Bastos, M., et al. (2014). Combined oral contraceptives: venous thrombosis. Cochrane Database of Systematic Reviews, (3). Amato, P. (2016, June 17). Fertility options for transgender persons. UCSF Transgender Care & Treatments and Guidelines. Accessed: April 12, 2021 Hembree, W. C., et al. (2017). Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society* Clinical Practice Guideline. The Journal of Clinical Endocrinology & Metabolism, 102(11), 3869–3903. Iwamoto, S. J., et al. (2019). Health considerations for transgender women and remaining unknowns: a narrative review. Therapeutic Advances in Endocrinology and Metabolism, 10, 1–27;. Deutsch, M. B. (Ed.). (2016, June 17). Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People. UCSF Transgender Care & Treatments and Guidelines. Accessed: April 12, 2021 Deutsch, M. (2016, June 17). Overview of masculinizing hormone therapy. UCSF Transgender Care & Treatments and Guidelines. Accessed: April 12, 2021 Unger, C. A. (2016). Hormone therapy for transgender patients. Translational Andrology and Urology, 5(6), 877–884. Irwig, M. S. (2018). Cardiovascular health in transgender people. Reviews in Endocrine and Metabolic Disorders, 19(3), 243–251. Bhasin, S., et al. (2018). Testosterone Therapy in Men With Hypogonadism: An Endocrine Society* Clinical Practice Guideline. The Journal of Clinical Endocrinology & Metabolism, 103(5), 1715–1744. Irwig, M. S. (2018). Cardiovascular health in transgender people. Reviews in Endocrine and Metabolic Disorders, 19(3), 243–251. Amato, P. (2016, June 17). Fertility options for transgender persons. UCSF Transgender Care & Treatments and Guidelines. Accessed: April 12, 2021 Hembree, W. C., et al. (2017). Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society* Clinical Practice Guideline. The Journal of Clinical Endocrinology & Metabolism, 102(11), 3869–3903. |