Meningiomas in three male-to-female transgender subjects using oestrogens/progestogens and review of the literature

Abstract

Sex hormones have been proposed as a possible risk factor for the development and growth of meningiomas. Hormonal therapy plays a fundamental role in the treatment of male-to-female transgenders and needs to be continued after sex reassignment surgery. Usually, this treatment leads to no adverse events; however, its impact on hormone-related tumours such as meningiomas has not yet been investigated thoroughly. We searched our cohort of 2810 male-to-female transgender persons, who have been treated between 1975 and 2010, for patients with meningiomas. Additionally, we conducted a literature search in PubMed and EMBASE. We found three patients who developed a meningioma in male-to-female transgenders in addition to five other who have been described in the literature. These findings support the role of female sex hormones in the development and growth of meningiomas. This might be an underrepresentation, because there is no standard protocol for screening for meningiomas in this population and meningiomas can remain asymptomatic for several years. We observed regression of multiple meningiomas in one of these three cases after discontinuation of hormonal treatment. The decision to stop or continue cross-sex hormone therapy in these particular patients should be carefully reconsidered individually.

Molecular Genetics of Intracranial Meningiomas with Emphasis on Canonical Wnt Signalling

“…In favour of this hypothesis are the findings that meningiomas show increased growth during pregnancy or during hormone replacement therapy [ 15 ]. Also, ter Wengel et al [ 16 ] found three patients who developed a meningioma in male-to-female transgenders. However, definite role of sex hormones as risk factors in the development and biology of meningiomas still needs to be established [ 16 ].…”

“…Also, ter Wengel et al [ 16 ] found three patients who developed a meningioma in male-to-female transgenders. However, definite role of sex hormones as risk factors in the development and biology of meningiomas still needs to be established [ 16 ]. Besides estrogen and progesterone receptors, meningiomas express androgen receptors too, as well as nonsteroidal hormone receptors including receptors for somatostatin and dopamine [ 14 ].…”

Multiple meningiomas in two male-to-female transsexual patients with hormone replacement therapy: A report of two cases and a brief literature review

“…A previous study from the Netherlands found that only 3 of 2810 male-to-female transsexual patients were diagnosed with meningiomas. [ 17 ] The authors further estimated the incidence of meningiomas in male-to-female transsexuals to be 126/100,000 (which appears to be higher than expected when compared with the observed incidences of 32.5/100,000 in males and 65/100,000 in females). [ 17 ] Yet, due to the low incidence and the missing high level of supportive evidence, no definitive imaging guidelines have been developed and it is probably not reasonable to recommend brain MRIs of all male-to-female transsexuals.…”

“…[ 18 ] A few previous case reports have described rapid development and growth of meningiomas in transsexual individuals taking sex-hormone replacement therapy (HRT). [ 8 9 15 17 ] On the other side of the spectrum, regression meningiomas after discontinuation of HRT have also been described. [ 5 10 17 ]…”

Emerging Medical Treatments for Meningioma in the Molecular Era

“…Higher incidence in meningioma was reported among breast cancer patients [ 135 ]. Although no evidenced-based studies demonstrated direct correlation between meningioma tumor growth and the reproductive hormone levels, the association between meningioma and reproductive hormones has been found in case reports and retrospective studies that suffer the limitation of patient number and confounding variables [ 136 , 137 ].…”