{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T12:03:54Z","timestamp":1776773034852,"version":"3.51.2"},"reference-count":12,"publisher":"American Society of Consultant Pharmacists","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["sr care pharm"],"published-print":{"date-parts":[[2024,9,1]]},"abstract":"<jats:p><jats:bold>Background<\/jats:bold> A transfeminine patient is a 79-year-old with past medical history significant for type 2 diabetes mellitus, hypertension, gender dysphoria, chronic kidney disease, dyslipidemia, total left hip replacement, and recent provoked deep venous thromboembolism (DVT).\n She was seen by a pharmacist in a primary care clinic after her discharge from a skilled nursing facility. The patient was experiencing symptoms of gender dysphoria after discontinuation of her estradiol in setting of her DVT.  <jats:bold>Assessment<\/jats:bold> Her renal function was calculated\n to ensure she was on appropriate dosing of her medications. Because her DVT was provoked, providers determined she would require only 3 months of anticoagulation. Her laboratory test results showed a subtherapeutic estradiol level and her estradiol was restarted. Additionally, aspirin was\n being prescribed for primary prevention of atherosclerotic cardiovascular disease and was discontinued.  <jats:bold>Outcome<\/jats:bold> She has significant improvement in her gender dysphoria symptoms with resuming her estradiol and now has a therapeutic estradiol level. She is tolerating her\n direct oral coagulant well and reports good quality of life.  <jats:bold>Conclusion<\/jats:bold> When reviewing medications for patients it is important to take several factors into account, including dose, appropriate indication, and patient preference. Pharmacists play a key role, through collaboration\n with providers, in assessing these medication-specific factors. Estradiol was stopped in this patient because of her DVT, but given her DVT was provoked after a recent surgery, it was unlikely that estradiol was the cause of her clot. Weighing the risks and benefits for any patient is important\n when determining what medications are appropriate to continue. Additionally, calculating renal function appropriately in a gender-non-conforming patients ensures appropriate and safe dosing.<\/jats:p>","DOI":"10.4140\/tcp.n.2024.319","type":"journal-article","created":{"date-parts":[[2024,8,24]],"date-time":"2024-08-24T04:49:14Z","timestamp":1724474954000},"page":"319-324","source":"Crossref","is-referenced-by-count":1,"title":["Geriatric Pharmacotherapy Case Series: Clotting and Gender-Affirming Care"],"prefix":"10.4140","volume":"39","author":[{"given":"Amanda","family":"Mertz","sequence":"first","affiliation":[{"name":"1 Veterans Affairs Northeast Ohio Healthcare System, Cleveland, Ohio."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Collin","family":"Fair","sequence":"additional","affiliation":[{"name":"1 Veterans Affairs Northeast Ohio Healthcare System, Cleveland, Ohio."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason","family":"Pol","sequence":"additional","affiliation":[{"name":"2 Cleveland Clinic, Cleveland, Ohio."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2625","reference":[{"issue":"6","key":"ref1","doi-asserted-by":"crossref","first-page":"e545","DOI":"10.1016\/j.chest.2021.07.055","article-title":"Antithrombotic therapy for VTE disease: second update of the CHEST guideline and expert panel report.","volume":"160","year":"2021","journal-title":"Chest"},{"key":"ref2","year":"2023","journal-title":"Titusville, NJ: Janssen Pharmaceuticals, Inc."},{"issue":"6","key":"ref3","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1093\/ajhp\/zxz355","article-title":"Implications for medication dosing for transgender patients: a review of the literature and recommendations for pharmacists.","volume":"77","year":"2020","journal-title":"Am J Health Syst Pharm"},{"issue":"7","key":"ref4","doi-asserted-by":"crossref","first-page":"2052","DOI":"10.1111\/jgs.18372","article-title":"updated AGS Beers Criteria\u00ae for potentially inappropriate medication use in older adults.","volume":"71","year":"2023","journal-title":"J Am Geriatr Soc"},{"issue":"5","key":"ref5","doi-asserted-by":"crossref","first-page":"1771","DOI":"10.1210\/jc.2012-4070","article-title":"Where are we 10 years after the women\u2019s health initiative?","volume":"98","year":"2013","journal-title":"J Clin Endocrinol Metab"},{"issue":"4","key":"ref6","doi-asserted-by":"crossref","first-page":"1586","DOI":"10.1210\/clinem\/dgaa966","article-title":"No venous thromboembolism increase among transgender female patients remaining on estrogen for gender-affirming surgery.","volume":"106","year":"2021","journal-title":"J Clin Endocrinol Metab"},{"issue":"1","key":"ref7","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1089\/trgh.2015.0008","article-title":"A systematic review of the effects of hormone therapy on psychological functioning and quality of life in transgender individuals.","volume":"1","year":"2016","journal-title":"Transgend Health"},{"issue":"16","key":"ref8","doi-asserted-by":"crossref","first-page":"1519","DOI":"10.1056\/NEJMoa1803955","article-title":"Effect of aspirin on all-cause mortality in the healthy elderly.","volume":"379","year":"2018","journal-title":"N Engl J Med"},{"issue":"16","key":"ref9","doi-asserted-by":"crossref","first-page":"1529","DOI":"10.1056\/NEJMoa1804988","article-title":"Study Collaborative Group. Effects of aspirin for primary prevention in persons with diabetes mellitus.","volume":"379","year":"2018","journal-title":"N Engl J Med"},{"issue":"16","key":"ref10","doi-asserted-by":"crossref","first-page":"1577","DOI":"10.1001\/jama.2022.4983","article-title":"Aspirin use to prevent cardiovascular disease: US Preventive Services Task Force recommendation statement.","volume":"327","year":"2022","journal-title":"JAMA"},{"issue":"4","key":"ref11","first-page":"30","article-title":"Pharmacists are vital to transitions of care.","volume":"89","year":"2023","journal-title":"Pharmacist Times"},{"key":"ref12","first-page":"2023","article-title":"Guidelines for the primary and gender-affirming care of transgender and nonbinary people.","volume":"6","year":"2016","journal-title":"Center of Excellence for Transgender Health."}],"container-title":["The Senior Care Pharmacist"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ingentaconnect.com\/content\/ascp\/tscp\/2024\/00000039\/00000009\/art00003","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,3]],"date-time":"2024-10-03T04:33:56Z","timestamp":1727930036000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ingentaconnect.com\/content\/10.4140\/TCP.n.2024.319"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,1]]},"references-count":12,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2024,9,1]]}},"alternative-id":["2639-9636(20240901)39:9L.319;1-"],"URL":"https:\/\/doi.org\/10.4140\/tcp.n.2024.319","relation":{},"ISSN":["2639-9636"],"issn-type":[{"value":"2639-9636","type":"print"}],"subject":[],"published":{"date-parts":[[2024,9,1]]}}}