Exogenous Sex Hormones and Postoperative Nausea and Vomiting Risk in Transgender Patients

Area of Science:

• Anesthesiology
• Endocrinology
• Surgical Care

Background:

• Postoperative nausea and vomiting (PONV) is a common concern in perioperative care.
• Limited understanding exists regarding PONV incidence and risk factors in transgender patients undergoing gender-affirming hormone therapy (GAHT).

Purpose of the Study:

• To investigate and compare the rates of PONV in transgender patients receiving GAHT versus cisgender patients.
• To evaluate the hypothesis that testosterone GAHT reduces PONV risk and estrogen GAHT increases PONV risk.

Main Methods:

• Retrospective cohort study utilizing the TriNetX database.
• Comparison groups: transgender and cisgender patients undergoing hysterectomy, orchiectomy, or augmentation mammoplasty.
• Propensity score matching for demographic and clinical variables; primary outcome was rescue antiemetic administration.

Main Results:

• Transgender males (AFAB) on testosterone GAHT showed a significantly different risk of rescue antiemetic use post-hysterectomy compared to cisgender females.
• Transgender females (AMAB) on estrogen GAHT had a significantly higher risk of rescue antiemetic use post-orchiectomy and augmentation mammoplasty compared to cisgender males and females, respectively.
• P-values: P = .0227 for hysterectomy, P < .0001 for orchiectomy, P = .0005 for augmentation mammoplasty.

Conclusions:

• Estrogen GAHT in transgender females correlates with increased need for rescue antiemetics after orchiectomy and augmentation mammoplasty.
• Testosterone GAHT in transgender males correlates with decreased need for rescue antiemetics after hysterectomy.
• Highlights the necessity for individualized perioperative care and antiemetic strategies for transgender patients, acknowledging study limitations and need for prospective research.