Transient Elevated Serum Prolactin in Trans Women Is Caused by Cyproterone Acetate Treatment

Defreyne, Justine; Nota, Nienke M.; Pereira, Cecilia; Schreiner, Thomas; Fisher, Alessandra D.; Heijer, Martin den; T’Sjoen, Guy

doi:10.1089/lgbt.2016.0190

Cited by 63 publications

(40 citation statements)

References 28 publications

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“…Cyproterone acetate is not available in the United States or Japan. Subtle differences in spironolactone and CPA effects on lipids and prolactin levels may result in the endocrinologist's choosing one over the other for the individual patient . Progestin agents when used alone at higher doses than for contraception, such as for dysfunctional uterine bleeding, are also associated with increased VTE risk but are not frequently used in the transgender population.…”

Section: Case I: Mtfmentioning

confidence: 99%

Transgender patients and the role of the coagulation clinician

Connors

2019

Journal of Thrombosis and Haemostasis

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The medical care of transgender patients relies on the use of sex hormones to develop and maintain the physical characteristics consistent with gender identity as the first step in transitioning. Hormonal therapy is usually continued indefinitely, even following gender‐affirming surgeries. The use of hormonal treatments is associated with a multitude of positive effects as well as complications and side effects. The risk of venous thromboembolism (VTE) is a major concern. Transgender patients are often referred to coagulation specialists for advice regarding an individual patient's risk for VTE, especially if there is a personal or family history of VTE. Coagulation specialists need to be familiar with endocrine therapy including the goals of treatment and the VTE risks associated with currently used hormone regimens. We will review common referral questions and the available data and their limitations for the use of hormonal therapy in transgender patients focusing on the risk of VTE.

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Section: Case I: Mtfmentioning

confidence: 99%

Transgender patients and the role of the coagulation clinician

Connors

2019

Journal of Thrombosis and Haemostasis

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“…Despite the absence of data, concerns have been raised about associations between GAHT with testosterone treatment in transgender males and erythrocytosis, hypertension, liver dysfunction, coronary artery disease, and cerebrovascular disease (14). Fluctuations in prolactin level have been noted in transgender females undergoing treatment with estradiol, but this association is not as well studied in the transgender male population (15)(16)(17). In transgender females, estrogen contributes to lactrotroph hyperplasia promoting the synthesis and the release of prolactin from the pituitary in a dose-dependent and duration-dependent fashion.…”

Section: Discussionmentioning

confidence: 99%

Hyperprolactinemia in a Transgender Male

Patel

Abramowitz

2020

AACE Clinical Case Reports

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Objective: We present a case of hyperprolactinemia in a transgender male. We discuss the various etiologies for hyperprolactinemia in this population of patients and discuss management options. Methods: We present a case report and review of the literature. A 29-year-old transgender male treated with gender-affirming hormone therapy with testosterone presented with hyperprolactinemia. Results: Labs revealed an elevated prolactin level. The patient completed further laboratory evaluation as well as imaging with a pituitary magnetic resonance imaging which all revealed normal results. He was wearing a tightly fitted breast binder while awaiting bilateral mastectomy. After bilateral mastectomy prolactin normalized, suggesting breast binding as the cause of the elevated prolactin. Conclusion: This is the only case in the literature which highlights breast binding as a possible cause of an elevated prolactin level. Our case report illustrates the various etiologies associated with an elevated prolactin level and highlights the importance of considering unique etiologies in populations such as transgender males.

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“…Both exogenous oestrogen and cyproterone acetate have been separately associated with increased serum prolactin levels in prospective cohort studies of transgender populations and oestradiol has been postulated to stimulate prolactin release . In fact, it may be the progestogenic effect of cyproterone acetate, not oestrogen, that is most important . In a retrospective cohort study of 38 male‐to‐female individuals, Nota and colleagues note that prolactin levels rose with the commencement of oestradiol and cyproterone acetate, but normalized to baseline levels following gonadectomy and cessation of cyproterone acetate.…”

Section: Discussionmentioning

confidence: 99%

“…29,30 In fact, it may be the progestogenic effect of cyproterone acetate, not oestrogen, that is most important. 31 In a retrospective cohort study of 38 male-tofemale individuals, Nota and colleagues note that prolactin levels rose with the commencement of oestradiol and cyproterone acetate, but normalized to baseline levels following gonadectomy and cessation of cyproterone acetate. This was despite an unchanged postoperative oestradiol dose.…”

Section: Prolactinomamentioning

confidence: 99%