Effects of antiandrogens on prolactin levels among transgender women on estrogen therapy: A systematic review

Wilson, Lisa M; Baker, Kellan; Sharma, Ritu; Dukhanin, Vadim; McArthur, Kristen; Robinson, Karen A.

doi:10.1080/15532739.2020.1819505

Cited by 16 publications

(17 citation statements)

References 36 publications

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“…Two studies compared a group of transgender women taking estrogen plus testosterone-lowering medications with a group who received only estrogen. The systematic review did not provide sufficient evidence to suggest any of the three testosterone-lowering medications had a better safety profile in terms of improved outcomes in bone health, testosterone levels, potassium levels, or in the incidence of hyperprolactinemia or meningiomas (Wilson et al., 2020 ). Therefore, no recommendation can be given.…”

Section: Chapter 12 Hormone Therapymentioning

confidence: 99%

“…The review did report spironolactone-based regimens were associated with a 45% increase in prolactin levels, whereas cyproterone-based regimens increased prolactin levels by more than 100%. However, the clinical significance of elevated prolactin levels is not clear because the rates of prolactinomas were not significantly elevated in either the spironolactone- or CPA-treated groups (Wilson et al., 2020 ). One retrospective, cohort study from a single center in the US reported no clinically significant increases in prolactin levels in 100 transgender women treated with estrogen plus spironolactone (Bisson et al., 2018 ).…”

Section: Chapter 12 Hormone Therapymentioning

confidence: 99%

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Standards of Care for the Health of Transgender and Gender Diverse People, Version 8

Coleman

Radix

Bouman

et al. 2022

International Journal of Transgender Health

1,064

492

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Background: Transgender healthcare is a rapidly evolving interdisciplinary field. In the last decade, there has been an unprecedented increase in the number and visibility of transgender and gender diverse (TGD) people seeking support and gender-affirming medical treatment in parallel with a significant rise in the scientific literature in this area. The World Professional Association for Transgender Health (WPATH) is an international, multidisciplinary, professional association whose mission is to promote evidence-based care, education, research, public policy, and respect in transgender health. One of the main functions of WPATH is to promote the highest standards of health care for TGD people through the Standards of Care (SOC). The SOC was initially developed in 1979 and the last version (SOC-7) was published in 2012. In view of the increasing scientific evidence, WPATH commissioned a new version of the Standards of Care, the SOC-8. Aim: The overall goal of SOC-8 is to provide health care professionals (HCPs) with clinical guidance to assist TGD people in accessing safe and effective pathways to achieving lasting personal comfort with their gendered selves with the aim of optimizing their overall physical health, psychological well-being, and self-fulfillment. Methods: The SOC-8 is based on the best available science and expert professional consensus in transgender health. International professionals and stakeholders were selected to serve on the SOC-8 committee. Recommendation statements were developed based on data derived from independent systematic literature reviews, where available, background reviews and expert opinions. Grading of recommendations was based on the available evidence supporting interventions, a discussion of risks and harms, as well as the feasibility and acceptability within different contexts and country settings. Results: A total of 18 chapters were developed as part of the SOC-8. They contain recommendations for health care professionals who provide care and treatment for TGD people. Each of the recommendations is followed by explanatory text with relevant references. General areas related to transgender health are covered in the chapters Terminology, Global Applicability, Population Estimates, and Education. The chapters developed for the diverse population of TGD people include Assessment of Adults, Adolescents, Children, Nonbinary, Eunuchs, and Intersex Individuals, and people living in Institutional Environments. Finally, the chapters related to gender-affirming treatment are Hormone Therapy, Surgery and Postoperative Care, Voice and Communication, Primary Care, Reproductive Health, Sexual Health, and Mental Health. Conclusions: The SOC-8 guidelines are intended to be flexible to meet the diverse health care needs of TGD people globally. While adaptable, they offer standards for promoting optimal health care and guidance for t...

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Section: Chapter 12 Hormone Therapymentioning

confidence: 99%

Section: Chapter 12 Hormone Therapymentioning

confidence: 99%

Standards of Care for the Health of Transgender and Gender Diverse People, Version 8

Coleman

Radix

Bouman

et al. 2022

International Journal of Transgender Health

1,064

492

View full text Add to dashboard Cite

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“…Helfand examined the recently updated WPATH Standards of Care and noted that it “incorporated elements of an evidence based guideline.” For one, WPATH commissioned a team at Johns Hopkins University in Maryland to conduct systematic reviews 3435. However, WPATH’s recommendations lack a grading system to indicate the quality of the evidence—one of several deficiencies.…”

Section: “Don’t Call Them Evidence Based”mentioning

confidence: 99%

Gender dysphoria in young people is rising—and so is professional disagreement

Block¹

2023

BMJ

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“…Additionally, at the completion of the 12 weeks, 90% of the patients in the CPA group achieved cisgender female range testosterone (<50 ng/dL) whereas only 19% of patients in the spironolactone group achieved female range testosterone. 71 However, due to its associated risks of rare but significant cases of meningiomas, hyperprolactinemia, and fulminant hepatitis, 16,72 it is not FDAapproved for use for GAHT in the United States, particularly where spironolactone, which bears less risk of hyperprolactinemia 47,73 and severe side effects, is readily available. CPA may have quicker impact in reducing serum testosterone levels; however, the risks associated with CPA as compared to spironolactone still must be further studied.…”

Section: Cpamentioning

confidence: 99%

“…10,44,46 A systematic review did not find that any one of these testosterone-lowering medications has a preferred overall safety profile. 47 While antiandrogens are effective at suppressing secondary male characteristics, they do not revert them. Therefore, the patient may continue to have a deepened voice or course hair growth, and many patients will pursue vocal training, voice feminization surgery, or cosmetic hair removal.…”

Section: Antiandrogensmentioning

confidence: 99%

Feminizing gender‐affirming hormone therapy for the transgender and gender diverse population: An overview of treatment modality, monitoring, and risks

Sudhakar

Huang

Zietkowski

et al. 2022

Neurourology and Urodynamics

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Aims Feminizing gender‐affirming hormone therapy (GAHT) can be utilized to help transfeminine transgender and gender diverse (TGD) individuals achieve the transformation of outward sex characteristics, thereby leading to improvements in psychological and social well‐being. In this narrative review, we aim to summarize current guidelines for feminizing GAHT management as well as the available literature describing the associated health risks pertaining to cardiovascular disease, thromboembolic disease, bone health, and cancer risks. Methods Relevant literature from January 2019 through July 2022 pertaining to feminizing GAHT was identified using PubMed, Cochrane Library, EMBASE, and MEDLINE. A narrative summary was performed with the inclusion of more recently published guidance from the World Professional Association for Transgender Health, Standards of Care Version 8. Results Guidance regarding the prescribing of feminizing GAHT with estrogen, antiandrogen, and progesterone medications is summarized along with considerations of the cardiovascular, thromboembolic, bone health, and cancer risks associated with these therapies. Conclusions Feminizing GAHT is a highly effective method for transfeminine TGD patients to achieve medically necessary changes in secondary sex characteristics. Knowledge of the health risks of feminizing GAHT is largely drawn from research in the cisgender population, with a growing body of literature in TGD‐specific patient populations. Feminizing GAHT appears to carry a low risk profile for most patients; however, further research describing the risks of hormone management around the time of gender‐affirming surgery and in the aging TGD population is needed to optimize GAHT in the context of the evolving health risks over a TGD patient's lifespan.

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Effects of antiandrogens on prolactin levels among transgender women on estrogen therapy: A systematic review

Cited by 16 publications

References 36 publications

Standards of Care for the Health of Transgender and Gender Diverse People, Version 8

Standards of Care for the Health of Transgender and Gender Diverse People, Version 8

Gender dysphoria in young people is rising—and so is professional disagreement

Feminizing gender‐affirming hormone therapy for the transgender and gender diverse population: An overview of treatment modality, monitoring, and risks

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