Diagnosis of prolactinoma in two male-to-female transsexual subjects following high-dose cross-sex hormone therapy

Abstract

Male-to-female transsexual persons use oestrogens + antiandrogens to adapt their physical bodies to the female sex. Doses are usually somewhat higher than those used by hypogonadal women receiving oestrogen replacement. Particularly in cases of self-administration of cross-sex hormones, doses may be very high. Oestrogens are powerful stimulators of synthesis and release of prolactin and serum prolactin levels are usually somewhat increased following oestrogen treatment. Prolactinomas have been reported in male-to-female transsexual persons, both after use of high and conventional doses of oestrogens but remain rare events. We report two new cases of prolactinomas in male-to-female transsexual persons, one in a 41-year-old subject who had used nonsupervised high-dose oestrogen treatment since the age of 23 years and another one in a 42 year old who had initiated oestrogen treatment at the age of 17 years. Their serum prolactin levels were strongly increased, and the diagnosis of a pituitary tumour was confirmed by imaging techniques. Both cases responded well to treatment with cabergoline treatment whereupon serum prolactin normalised. Our two cases are added to the three cases of prolactinomas in the literature in persons who had used supraphysiological doses of oestrogens.

Hormone therapy in transgender adults is safe with provider supervision; A review of hormone therapy sequelae for transgender individuals

“…There are multiple case reports of conditions associated with MTF HT, including the incidence of meningiomas [43–45], benign pituitary tumors and prolactinomas [61–65] along with the occurrence of autoimmune conditions with a female predominance, such as systemic lupus erythematosus [69,70]. However, the data are too limited to make any type of conclusion or recommendation.…”

“…There are reports of enlarged pituitary glands among MTF individuals on HT [60], as well as six case reports of prolactinoma [61–64]. Prolactin levels have also been reported to be elevated among MTF individuals during long-term HT [60].…”

Cancer in Transgender People: Evidence and Methodological Considerations

“…Current literature includes 8 case reports of prolactinoma in transwomen treated with hormonal therapy (16,(58)(59)(60)(61)(62). In 4 cases, hormonal therapy included cyproterone acetate, and all patients presented with highly elevated prolactin levels.…”

Priorities for transgender medical and healthcare research

“…The literature contains multiple case reports of conditions that are observed in persons undergoing feminizing hormone therapy, including the incidence of meningiomas [56,57], benign pituitary tumors and prolactinomas [58]. There are reports of the occurrence of autoimmune conditions with a female predominance, such as systemic lupus erythematosus [59].…”