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Estrogen therapy and the consideration of its potential side effects will continue to grow as the number of transgender females presenting to health care services continues to increase. The risks of estrogen therapy in this population are hard to extrapolate from previously identified data in the general population due to variation in birth sex, superior hormone doses required, and extended exposure duration that is often needed. Estrogen therapy is a rare, yet well-known, cause of acute pancreatitis with as many as 40 known reported cases in women and only one other reported case in a transgender female. The presumed mechanism is estrogen-induced hypertriglyceridemia as triglyceride levels were documented as greater than 1,000 mg/dL in most diagnosed patients. The limited data and evidence-based recommendations regarding estrogen therapy treatment and management in transgender women have led to a general lack of understanding among most practitioners. The long-term supraphysiologic doses of sex hormones required for treatment in transgender women and the dose-dependent estrogen-induced elevation in triglycerides are factors that contribute to an increased risk of pancreatitis. Therefore, the utility of regularly scheduled lipid panels in the prevention of pancreatitis increases in this population.

Abstract. Human rabies is a fatal disease, transmitted by saliva of infected animals, and the diagnosis requires a high index of suspicion. Very few cases are reported annually in the United States. We present a case of human rabies without a clear exposure history that masqueraded as serotonin syndrome.

Purpose The case of a transgender female who developed gallstone pancreatitis in the context of estrogen use for gender-affirming hormone therapy is reported. Summary A 24-year-old Caucasian transgender female presented to the emergency department for abdominal pain and vomiting after referral from urgent care for suspected pancreatitis. Her home medications included estradiol, medroxyprogesterone, and spironolactone for gender-affirming hormone therapy and omeprazole for reflux. The patient reported minimal alcohol intake, presented with mildly elevated triglyceride levels, and did not have a family history of pancreatitis or gallstone disease. She underwent a laparoscopic cholecystectomy on hospital day 4 and was given a postoperative diagnosis of chronic cholecystitis, cholelithiasis, and pancreatitis. Given her history and the present illness, the use of estrogen therapy is a likely risk factor for the development of gallstone pancreatitis. Conclusion Estrogen is a cornerstone of gender-affirming hormone therapy used by transgender women; however, in addition to its role in gender identity confirmation, estrogen can result in drug-induced pancreatitis.