When thinking about whether transgender people need to stop their hormone treatments before surgery, it’s helpful to look at what happens with cisgender people (those whose gender identity matches their sex at birth). Cisgender people don’t have to suppress their body’s natural hormones before they have surgery, since it is neither more favorable to have a testosterone nor an estrogen based hormone profile for anyone undergoing surgery. So, it raises the question: why should transgender people have to stop their hormones and revert to their natural profile?

Recent studies are starting to show that stopping natural hormone treatments might not be necessary. For example, a big review of different studies found that there isn’t much proof that hormone treatments cause problems during surgery. Another study, specifically looking at transgender men having chest surgery, found that keeping on testosterone didn’t really change the risks of surgery.

Based on recent thought, evidence and studies, it appears that stopping gender-affirming hormones prior to surgery may not be necessary for transgender individuals as it was once thought to be.

This conclusion is drawn from several sources:

1. A study published in the Journal of Clinical Endocrinology and Metabolism examined data on 919 transgender patients undergoing gender-affirming surgery. It found no difference in thrombosis rates when estrogen hormone therapy was maintained during surgery. This study challenges the traditional recommendation for transgender women to stop hormone therapy before surgery due to thrombotic risks. Notably, one patient who stopped estrogen prior to surgery experienced a venous thromboembolism Can Patients Safely Continue Estrogen During Gender-Affirming Surgery? | ASH Clinical News | American Society of Hematology.
2. A systematic review, as reported by MedPage Today, found little evidence supporting the suspension of hormone therapy prior to surgery. The review included various studies assessing perioperative risks associated with hormone use. This review noted that the routine practice of suspending cross-sex hormone treatment prior to surgery limits available data on transgender populations. It also highlighted the need for individual risk assessment in such cases until further research provides more conclusive data Rethink Due for Stopping Transgender Hormone Tx Before Surgery? | MedPage Today.
3. A study focusing on gender-affirming mastectomy ("top surgery") and the management of perioperative testosterone therapy found that routine cessation of testosterone is not necessary. This retrospective review included 490 patients and showed no significant difference in postoperative complication rates among those who continued versus those who discontinued testosterone therapy during the perioperative period Perioperative Hormone Management in Gender-Affirming Mastectomy: Is Stopping Testosterone before Top Surgery Really Necessary? – PubMed.

It’s becoming increasingly important to consider the hormone profiles of transgender individuals in the same light as those of cisgender people, especially in the context of their medical treatments and surgeries.

This perspective encourages the avoidance of discrimination and ensures equitable treatment in healthcare. When advising transgender people about continuing or stopping hormone therapy before surgery, healthcare providers must weigh both the potential benefits and risks of advising them to stop, and of advising them to continue.

Recent studies have shown that the need to stop hormone therapy is not necessary, emphasizing the importance of individualized medical care based on current research and best practices.