What Do Transgender Patients Teach Us About Idiopathic Intracranial Hypertension?

Abstract

Idiopathic intracranial hypertension (IIH), a condition of raised intracranial pressure, is characterised by headaches and visual disturbances. Its pathogenesis is currently unknown; however, dysregulation of androgens may be implicated. Here, the authors present a case of a 22-year-old patient undergoing female-to-male (FTM) gender reassignment who developed IIH shortly after commencing testosterone therapy. This interesting case presents the possibility of androgens having a pathogenic role in IIH.

Eye Conditions in Women

“…133 There are case reports of transgender males who developed IIH after commencement of testosterone therapy. [134][135][136][137][138] These results should be considered with caution as confounding factors such as weight gain may also have contributed elevated intracranial pressure. Furthermore, polycystic ovary syndrome, which has a cardinal defining feature of androgen excess, has a much higher prevalence in women with IIH (up to 57%) compared to the general female population (5%-10%).…”

“…143 One possible explanation for this seeming paradox was posited by Hornby et al There may be a window of abnormal serum testosterone levels that is shared by men with androgen deficiency and women with androgen excess and in which there is an increased risk of developing IIH. 138 In addition, testosterone has been shown to exhibit sexually dimorphic effects on human metabolism. 144 Differences in signaling or sensitivity to androgen receptors between the sexes or epigenetic modifications to local androgen action may help explain this sexually dimorphic response.…”

“…As a result, leptin resistance has been theorized as a potential causative factor in the development of IIH. 138,148…”

“…As a result, leptin resistance has been theorized as a potential causative factor in the development of IIH. 138,148 When sex-based differences exist in presentation or outcome of a disease entity, gender-based differences in healthcare-seeking behavior must also be considered. Two studies looking at the differences in IIH between men and women have shown that the time from the onset of first symptoms to diagnosis was shorter in men.…”

Metabolic Concepts in Idiopathic Intracranial Hypertension and Their Potential for Therapeutic Intervention

“…Case reports of transgender patients undergoing female to male gender reassignment provide important insights into the role of androgens in IIH. Five case reports detail that patients receiving testosterone injections subsequently developed IIH, 4 of whom showed a temporal relationship between commencement of testosterone and symptoms of IIH (Table 1) (42–46). There needs to be caution when interpreting these reports because confounders such as weight gain may have influenced the development of increased ICP.…”