SHM Converge Scientific Abstract ePoster Gallery-Cross-Sex Hormone Therapy Complicated by Frequent Sickle Cell Vaso-Occlusive Crises

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This case report describes a 25-year-old Black transgender woman with HbSS sickle cell disease (SCD) receiving cross-sex hormone therapy (CSHT) with estrogen for male-to-female transition. She had a history of acute chest syndrome, chronic left upper extremity DVT, and recurrent painful vaso-occlusive crises (VOC). She was admitted with severe back and leg pain consistent with prior VOC, along with leukocytosis and hemoglobin slightly below baseline. She improved after transfusion, opioid pain control, and supportive care, and was discharged on oral opioids.<br /><br />The report highlights an important clinical uncertainty: both SCD and exogenous estrogen are independently associated with increased thromboembolic risk, but the effect of estrogen-based CSHT on VOC frequency in transgender patients with SCD is unknown. In this patient, VOCs became frequent enough to require nine hospitalizations in one year while she continued CSHT. Despite discussion of possible increased risk, she consistently chose to remain on hormone therapy because it was central to her identity and quality of life.<br /><br />The authors note that current literature is very limited. Existing reports on transgender patients with SCD are sparse, and older estrogen-related data in cisgender women often involve ethinyl estradiol, which is not the same as the 17-β estradiol typically used in CSHT. Therefore, those findings cannot be directly applied to transgender women.<br /><br />The case emphasizes the need for more research on VOC risk in transgender people with SCD, better guidance for managing hormone therapy in this population, and strong patient advocacy. It also underscores how treatment decisions in transgender patients with SCD are deeply tied to self-identity and overall quality of life.

Asset Subtitle

Emily Jane Taylor

Meta Tag

Author List Cindy L. Tsui, Emily Jane Taylor

Category Clinical Vignettes

Concept Gender-Affirming Hormone Therapy

Concept Estrogen Therapy

Concept Sickle Cell Disease

Concept Vaso-occlusive Pain

Concept Thromboembolic Risk

Distinguished Non-Finalist

Presenter Organization NYU Langone Health

Presenting Author Emily Jane Taylor

Track Adult

Keywords

sickle cell disease

HbSS

cross-sex hormone therapy

estrogen

transgender woman

vaso-occlusive crisis

thromboembolic risk

acute chest syndrome

deep vein thrombosis

patient advocacy

Gender-Affirming Hormone Therapy

Estrogen Therapy

Sickle Cell Disease

Vaso-occlusive Pain

Thromboembolic Risk