Meningioma: The Unusual Growth in a Transsexual Patient after Estrogen-Progesterone Therapy

Borghei-Razavi, Hamid; Fragoza-Padilla, Valente; Hargus, Gunnar; Bakhti, Sahar; Schick, Uta

doi:10.15226/2374-6858/1/2/00109

Cited by 5 publications

(4 citation statements)

References 20 publications

(20 reference statements)

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“…Since 2007, several case series of both men and women have reported meningioma associated with prolonged use (5-30 years) of high dose cyproterone acetate (25-100 mg daily). [1][2][3][4][5][6][7][8][9][10][11] The labelling of cyproterone acetate (10,50, and 100 mg) was modified in 2009, 12 and since 2011 and 2013 the labelling of both the brand name drug and generic drugs, respectively, indicate that meningiomas have been reported in people with prolonged use of cyproterone acetate. 13 A history or presence of meningioma now also constitutes a contraindication to use of cyproterone acetate.…”

Section: Introductionmentioning

confidence: 99%

Use of high dose cyproterone acetate and risk of intracranial meningioma in women: cohort study

Weill¹,

Nguyen

Labidi

et al. 2021

BMJ

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Objective To assess the risk of meningioma associated with use of high dose cyproterone acetate, a progestogen indicated for clinical hyperandrogenism. Design Observational cohort study. Setting Data from SNDS, the French administrative healthcare database, between 2007 and 2015. Participants 253 777 girls and women aged 7-70 years living in France who started cyproterone acetate between 2007 and 2014. Participants had at least one reimbursement for high dose cyproterone acetate and no history of meningioma or benign brain tumour, or long term disease status. Participants were considered to be exposed when they had received a cumulative dose of at least 3 g during the first six months (139 222 participants) and very slightly exposed (control group) when they had received a cumulative dose of less than 3 g (114 555 participants). 10 876 transgender participants (male to female) were included in an additional analysis. Main outcome measure Surgery (resection or decompression) or radiotherapy for one or more intracranial meningiomas. Results Overall, 69 meningiomas in the exposed group (during 289 544 person years of follow-up) and 20 meningiomas in the control group (during 439 949 person years of follow-up) were treated by surgery or radiotherapy. The incidence of meningioma in the two groups was 23.8 and 4.5 per 100 000 person years, respectively (crude relative risk 5.2, 95% confidence interval 3.2 to 8.6; adjusted hazard ratio 6.6, 95% confidence interval 4.0 to 11.1). The adjusted hazard ratio for a cumulative dose of cyproterone acetate of more than 60 g was 21.7 (10.8 to 43.5). After discontinuation of cyproterone acetate for one year, the risk of meningioma in the exposed group was 1.8-fold higher (1.0 to 3.2) than in the control group. In a complementary analysis, 463 women with meningioma were observed among 123 997 already using cyproterone acetate in 2006 (risk of 383 per 100 000 person years in the group with the highest exposure in terms of cumulative dose). Meningiomas located in the anterior skull base and middle skull base, particularly the medial third of the middle skull base, involving the spheno-orbital region, appeared to be specific to cyproterone acetate. An additional analysis of transgender participants showed a high risk of meningioma (three per 14 460 person years; 20.7 per 100 000 person years). Conclusions A strong dose-effect relation was observed between use of cyproterone acetate and risk of intracranial meningiomas. A noticeable reduction in risk was observed after discontinuation of treatment.

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Section: Introductionmentioning

confidence: 99%

Use of high dose cyproterone acetate and risk of intracranial meningioma in women: cohort study

Weill¹,

Nguyen

Labidi

et al. 2021

BMJ

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“…Micronized progesterone may be better tolerated and may have a more favorable impact on the lipid profile than medroxyprogesterone (Fitzpatrick et al, 2000). When paired with estrogens for transgender women, the progestin cyproterone acetate is associated with elevated prolactin, decreased HDL cholesterol, and rare meningiomas-none of which are seen when estrogens are paired with GnRH agonists or spironolactone (Bisson, 2018;Borghei-Razavi, 2014;Defreyne, Nota et al, 2017;Sofer et al, 2020).…”

Section: Statement 1211mentioning

confidence: 99%

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

Coleman¹,

AE²,

WP³

et al. 2023

ESPE

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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 the treatment of people experiencing gender incongruence. As in all previous versions of the SOC, the criteria set forth in this document for gender-affirmi...

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“…The literature contains case reports of conditions that are observed in people undergoing feminizing hormone therapy even when there is not much underlying expectation of a causal relationship. Reports include transgender individuals with meningiomas (96,97), prolactinomas (98), and other pituitary tumors.…”

Section: Hormone Treatment and Other Conditionsmentioning

confidence: 99%

Research gaps in medical treatment of transgender/nonbinary people

Safer¹

2021

Journal of Clinical Investigation

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Meningioma: The Unusual Growth in a Transsexual Patient after Estrogen-Progesterone Therapy

Cited by 5 publications

References 20 publications

Use of high dose cyproterone acetate and risk of intracranial meningioma in women: cohort study

Use of high dose cyproterone acetate and risk of intracranial meningioma in women: cohort study

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

Research gaps in medical treatment of transgender/nonbinary people

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