Reframing Hematologic and Thrombovascular Care for Transgender and Gender-Diverse Individuals: A Scoping Review

Transgender and gender-diverse (TGD) individuals experience well-documented inequities in healthcare access and quality. Within hematologic and thrombovascular (thrombosis and vascular medicine) care, existing literature has largely emphasized physiologic risk, particularly thromboembolic risk associated with gender-affirming hormone therapy (GAHT), while less attention has been paid to how care is delivered, experienced, and operationalized across clinical settings. The objective of this review was to map and synthesize the literature describing the delivery of hematologic and thrombovascular care for TGD individuals, with a focus on care gaps, facilitators, provider preparedness, and patient experience. We conducted a scoping literature review following PRISMA-ScR guidelines. MEDLINE, Embase, EmCare, and PsycINFO were searched from inception to July 1, 2025. Eligible sources included qualitative, quantitative, and mixed-methods studies addressing hematologic or thrombovascular care in TGD populations. Findings were synthesized descriptively and thematically. Thirty one articles met inclusion criteria. Four dominant themes emerged: (1) narrow biomedical framing of thrombovascular risk; (2) variability and uncertainty in clinical decision-making; (3) patient-reported barriers related to stigma, misgendering, and fragmented care; and (4) limited provider training and system-level preparedness. Evidence addressing longitudinal management, shared decision-making, and interdisciplinary care models was sparse. The existing literature on TGD hematologic and thrombovascular care is limited in scope and heavily weighted toward risk reporting/management rather than care delivery. Substantial gaps remain in evidence informing best practices, provider education, and system design. These findings underscore the need for inclusive clinical guidance, education, and consensus-building initiatives.