Journal
ENDOCRINE CONNECTIONS
Volume 8, Issue 7, Pages 935-940Publisher
BIOSCIENTIFICA LTD
DOI: 10.1530/EC-19-0272
Keywords
transgender persons; transsexualism; gender identity; gender dysphoria; androgens
Categories
Funding
- Australian Government National Health and Medical Research Council Early Career Fellowship [1143333]
- Viertel Charitable Foundation Clinical Investigator Award
- Endocrine Society of Australia Postdoctoral Award
- Royal Australasian College of Physicians Vincent Fairfax Family Foundation
Ask authors/readers for more resources
Background: Oestradiol with or without an anti-androgen (cyproterone acetate or spironolactone) is commonly prescribed in transfeminine individuals who have not had orchidectomy; however, there is no evidence to guide optimal treatment choice. Objective: We aimed to compare add-on cyproterone acetate versus spironolactone in lowering endogenous testosterone concentrations in transfeminine individuals. Design: Retrospective cross-sectional study. Methods: We analysed 114 transfeminine individuals who had been on oestradiol therapy for >6 months in two gender clinics in Melbourne, Australia. Total testosterone concentrations were compared between three groups; oestradiol alone (n = 21), oestradiol plus cyproterone acetate (n = 21) and oestradiol plus spironolactone (n = 38). Secondary outcomes included serum oestradiol concentration, oestradiol valerate dose, blood pressure, serum potassium, urea and creatinine. Results: Median age was 27.0 years (22.5-45.1) and median duration of hormone therapy was 1.5 years (0.9-2.6), which was not different between groups. On univariate analysis, the cyproterone group had significantly lower total testosterone concentrations (0.8 nmol/L (0.6-1.20)) compared with the spironolactone group (2.0 nmol/L (0.9-9.4), P = 0.037) and oestradiol alone group (10.5 nmol/L (4.9-17.2), P < 0.001), which remained significant (P = 0.005) after adjustments for oestradiol concentration, dose and age. Serum urea was higher in the spironolactone group compared with the cyproterone group. No differences were observed in total daily oestradiol dose, blood pressure, serum oestradiol, potassium or creatinine. Conclusions: The cyproterone group achieved serum total testosterone concentrations in the female reference range. As spironolactone may cause feminisation without inhibition of steroidogenesis, it is unclear which anti-androgen is more effective at feminisation. Further prospective studies are required.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available