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Hyperprolactinemia and association with prolactinoma in transwomen receiving gender affirming hormone treatment

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Abstract

Purpose

Approximately 0.6% of the adult population identifies as transgender. Gender affirming hormone treatment (GAHT) is required by many to develop physical and psychological characteristics that align with their gender identity. Once started, GAHT is continued lifelong and at higher doses than conventionally used in the management of cis-gendered women. Hyperprolactinemia and pituitary lactotroph adenomas are a potential consequence of GAHT.

Methods

Case series of three transfeminine women with hyperprolactinemia during gender affirming hormone treatment.

Results

We report two new cases of prolactinoma and one new case of marked hyperprolactinemia without pituitary adenoma associated with GAHT in transwomen at different stages of hormonal transition. Novel aspects of our case series include the first report of a prolactinoma in a transwoman associated with spironolactone and the alternate progestin medroxyprogesterone acetate and documentation of the transient changes in prolactin from baseline (prior to feminizing hormones) in two transwomen which demonstrate that marked hyperprolactinemia develops early in the course of GAHT.

Conclusions

Transgender women receiving GAHT may be at increased risk for prolactinoma. As the number of transwomen seeking GAHT continues to increase, hyperprolactinemia and GAHT-associated prolactinoma may become an increasingly important component of endocrine practice. Screening of prolactin levels in transwomen receiving GAHT could potentially prevent morbidity related to hyperprolactinemia and allow for early detection of prolactin secreting pituitary adenomas.

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Author contributors

L.M.R. and C.A.M. designed the study, interpreted the results and drafted and approved all versions of the manuscript. M.G.J. drafted and approved all versions of the manuscript.

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Authors and Affiliations

  1. Department of Endocrinology, St. Vincent’s Hospital, Sydney, NSW, Australia

    Lisa M. Raven & Christopher A. Muir

  2. Alice Street Medical Practice, Sydney, NSW, Australia

    Michelle Guttman-Jones

Authors
  1. Lisa M. Raven
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  2. Michelle Guttman-Jones
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Correspondence to Christopher A. Muir.

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Conflict of interest

L.M.R. declares that she has no conflict of interest, M.G.J. declares that she has no conflict of interest, C.A.M. declares that he has no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Raven, L.M., Guttman-Jones, M. & Muir, C.A. Hyperprolactinemia and association with prolactinoma in transwomen receiving gender affirming hormone treatment. Endocrine 72, 524–528 (2021). https://doi.org/10.1007/s12020-020-02563-3

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