{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:07:23Z","timestamp":1789085243690,"version":"build-2803163510"},"reference-count":34,"publisher":"Georg Thieme Verlag KG","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Thromb Haemost"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Sublingual estradiol is increasingly used for gender-affirming hormone therapy (GAHT), but its chronic hemostatic effects remain insufficiently characterized.<\/jats:p>\n                  <jats:p>To compare hemostatic changes between oral estradiol plus cyproterone acetate (CPA) with divided-dose sublingual estradiol monotherapy in treatment-naive transgender women.<\/jats:p>\n                  <jats:p>In this prospective, non-randomized study, 30 treatment-na\u00efve transgender women received oral estradiol 2\u2009mg once daily plus CPA 10\u2009mg daily (n\u2009=\u200915) or sublingual estradiol 0.5\u2009mg four times daily without an anti-androgen (n\u2009=\u200915) for 6 months. Free protein S antigen, protein C, thrombin generation assay (TGA), and thromboelastography (TEG) were assessed at baseline and 6 months.<\/jats:p>\n                  <jats:p>Free protein S antigen decreased in all participants receiving sublingual estradiol (median change, \u2212\u200922%; p\u2009&lt;\u20090.001), compared with a smaller, heterogeneous change with oral estradiol plus CPA (median change, \u2212\u20094.2%; p\u2009=\u20090.099). At 6 months, median free protein S antigen was 77% versus 106%, respectively (p\u2009=\u20090.003). After adjustment for baseline protein S and age, sublingual treatment remained associated with lower 6-month levels (B\u2009=\u2009\u221215.8; p\u2009&lt;\u20090.001). TGA lag time decreased by a median of 19% in the sublingual group, but the between-group difference was not significant after correction (adjusted p\u2009=\u20090.063). TEG maximum amplitude increased modestly with oral estradiol plus CPA and differed between groups after correction (adjusted p\u2009=\u20090.009), although values remained within physiological ranges. No thrombotic events occurred.<\/jats:p>\n                  <jats:p>The two GAHT protocols were associated with distinct laboratory hemostatic patterns, suggesting that different GAHT regimens should not be considered hemostatically equivalent. These findings warrant further evaluation in larger studies.<\/jats:p>","DOI":"10.1055\/a-2945-4864","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T23:01:16Z","timestamp":1787958076000},"source":"Crossref","is-referenced-by-count":0,"title":["Divergent Effects of Estradiol Regimens on Protein S and Global Coagulation in Transgender Women: A Prospective Pilot Study"],"prefix":"10.1055","clinical-trial-number":[{"clinical-trial-number":"nct07145281","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Shelly","family":"Bar-On","sequence":"first","affiliation":[{"name":"Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv District, Israel","place":["Tel Aviv"]},{"name":"The Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv District, Israel","place":["Tel Aviv"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3290-7291","authenticated-orcid":false,"given":"Merav","family":"Barzilai","sequence":"first","affiliation":[{"name":"The Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv District, Israel","place":["Tel Aviv"]},{"name":"Rabin Medical Center \u2013 Beilinson Campus, Israel","place":["Petah Tikva"],"department":["Division of Hematology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Tordjman","sequence":"first","affiliation":[{"name":"Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv District, Israel","place":["Tel Aviv"]},{"name":"The Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv District, Israel","place":["Tel Aviv"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iris","family":"Yaish","sequence":"first","affiliation":[{"name":"Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv District, Israel","place":["Tel Aviv"]},{"name":"The Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv District, Israel","place":["Tel Aviv"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yona","family":"Greenman","sequence":"additional","affiliation":[{"name":"Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv District, Israel","place":["Tel Aviv"]},{"name":"The Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv District, Israel","place":["Tel Aviv"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Galia","family":"Spectre","sequence":"additional","affiliation":[{"name":"The Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv District, Israel","place":["Tel Aviv"]},{"name":"Rabin Medical Center \u2013 Beilinson Campus, Israel","place":["Petah Tikva"],"department":["Division of Hematology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irina","family":"Shalev","sequence":"additional","affiliation":[{"name":"Tel Aviv Sourasky Medical Center, Tel Aviv, Israel","place":["Tel Aviv"],"department":["Division of Clinical Laboratories"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ben-Zion","family":"Katz","sequence":"additional","affiliation":[{"name":"The Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv District, Israel","place":["Tel Aviv"]},{"name":"Tel Aviv Sourasky Medical Center, Tel Aviv, Israel","place":["Tel Aviv"],"department":["Division of Clinical Laboratories"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esther","family":"Ziv","sequence":"additional","affiliation":[{"name":"Rabin Medical Center 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