Intracranial Hypertension in a Transgender Man

Abstract

ObjectiveCase description of recurrent idiopathic intracranial hypertension (IIH) in a transgender man on gender-affirming hormone therapy.MethodsCase report.ResultsA 24-year-old transmasculine patient (assigned female at birth), with a body mass index (BMI) of 37.3, presented with headaches, transient visual obscurations (TVOs), pulsatile tinnitus, Frisén 5 papilledema, and scotomas. He was diagnosed with IIH after normal magnetic resonance imaging (MRI) and magnetic resonance venogram (MRV), an elevated opening pressure of 27 cm water, and normal cerebrospinal fluid studies. IIH resolved with acetazolamide and optic nerve sheath fenestration (ONSF). He then started gender-affirming testosterone therapy and was on this for 20 months when his headaches, pulsatile tinnitus, TVOs, and Frisén 3 papilledema recurred at a BMI of 31. Brain MRI and MRV were normal. Opening pressure was elevated at 31 cm. water. Acetazolamide 4 g/day did not improve the papilledema, thus a left ONSF was repeated resulting in eventual resolution of the IIH.DiscussionSeveral reports have been published of IIH development in patients receiving testosterone therapy. Hormone prescribers for gender affirmation may wish to screen for visual loss and optic nerve edema in patients undergoing testosterone therapy, which may also stimulate appetite weight gain.

Limitations and Future Directions in Sex, Sexuality, and Gender Diverse Research in Neurology

“…More than 70% of the reviewed studies were focused on neurological sequelae of human immunodeficiency virus (HIV). Since that time, there has been progress, with studies published related to movement disorders, 16,17 multiple sclerosis, 18 stroke, 13,19 headache, 8,20 sleep, 21 and cognitive disorders. [22][23][24] Neurology research on intersex individuals is limited.…”

Inclusion of Historically Oppressed Genders in Neurologic Practice Research

“…In this issue of Neurology® Clinical Practice , Qureshi et al 1 present a case of a transgender man of childbearing age with a reported body mass index of 37 who presents with idiopathic intracranial hypertension (IIH). The authors conclude that exogenous testosterone as part of a gender-affirming hormone regimen may be a potential mechanism for his diagnosis of IIH, based on prior evidence that disorders in androgen metabolism may influence CSF production.…”