To stress the importance of individualized vascular risk assessment and shared decision-making to continue Gender-Affirming Hormonal therapy (GAHT) in the Male to Female (MTF) transgender population following ischemic stroke with review of the literature.  

Transgender individuals have higher mental health burden and suicide rates.  GAHT is the standard of care for transgender individuals suffering from symptoms of gender dysphoria. Estrogen therapy has been associated with increased stroke risk, but its specific contribution is poorly characterized and appears to be impacted by the route of administration. 

We include three self-identified MTF transgender patients who had taken GAHT and treated for ischemic stroke inpatient or were seen for stroke follow-up.  Data was gathered from chart review including demographics, vascular risk factors, type of GAHT, clinical course, and outcomes.  

Two MTF transgender patients on GAHT were treated inpatient for an acute stroke and one was seen in follow up. At the time of infarct, one MTF transgender patient was on combination hormonal therapy, one patient was on combination hormonal therapy and spironolactone, and one patient was on estrogen hormonal therapy of unknown type. Traditional vascular risk factors were present in the patient population prior to ischemic stroke including: hypertension, hyperlipidemia, type 2 diabetes mellitus, morbid obesity, prior ischemic stroke, tobacco use disorder, alcohol use disorder.