Use sex-hormone drugs only when a doctor has prescribed them and you have regular follow-up checks; don't buy them online or raise the dose yourself

Cost

Regular registration fees, plus blood tests for follow-up. A few hundred CNY a year and a few half-days.

What you get

The researchers followed a group of people through the electronic health records of Kaiser Permanente, a health care group. Among them were 2,842 transgender women and 2,118 transgender men, followed for an average of 4.0 years and 3.6 years. Each person was matched by birth year, race, clinic and time of enrollment to about 10 times as many cisgender controls, 48,686 cisgender men and 48,775 cisgender women in all. Venous thromboembolism (a blood clot forming and blocking a vessel) was more common in transgender women than in controls. Compared with cisgender men, it was 4.1 cases per 1000 people at 2 years (95% CI 1.6–6.7). At 8 years it was 16.7 cases (6.4–27.5). In other words, out of 1000 people there were 4.1 more cases at two years and 16.7 more at eight years. Compared with cisgender women, the two numbers were 3.4 (1.1–5.6) and 13.7 (4.1–22.7). Ischemic stroke (the kind of stroke caused by a blocked vessel) and myocardial infarction were similar across groups overall. But among transgender women who began hormone therapy only during follow-up, the difference in venous clots and ischemic stroke was larger. For transgender men the evidence was insufficient to draw a conclusion. The authors concluded: “these results may suggest a need for long-term vigilance about the vascular side effects of estrogen in transgender hormone therapy.”

Notes

The researchers themselves note a weakness of this study: they could not see how many people bought their drugs on their own outside the health system, so the line for “whether the drug was used” could never be drawn cleanly. That is exactly why drug use belongs in proper follow-up. This study looked only at whether vascular problems occurred; it does not answer whether hormone therapy should be used or what benefits it brings, which is a different body of evidence. It is the same in every situation where sex hormones are used, including contraceptive pills, menopausal hormone therapy and testosterone supplements. Whenever people buy online, adjust the dose from forum posts and never check for clots or liver and kidney values, the risk lies in the stretch where no one is watching, and has nothing to do with why the drug is taken. The proper route in China is to go to the endocrinology department or the relevant specialty at a regular medical institution for assessment, prescription and follow-up.

Evidence grade

A : Specific numbers from meta-analyses, large cohorts or randomized trials; for law and policy, the statute or official text.

Sources

1. Getahun D et al. (2018). Cross-sex Hormones and Acute Cardiovascular Events in Transgender Persons: A Cohort Study. Ann Intern Med. https://doi.org/10.7326/M17-2785
2. 国家市场监督管理总局 (2022). 药品网络销售监督管理办法（总局令第 58 号，第九条）. https://www.gov.cn/gongbao/content/2022/content_5717002.htm

Translated from the Chinese original. Original book, section 28, tip 7. This section is about health and medicines. It is general information, not a substitute for a doctor’s diagnosis or prescription. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer