Predictive Markers for Mammoplasty and a Comparison of Side Effect Profiles in Transwomen Taking Various Hormonal Regimens

• Published in: The journal of clinical endocrinology and metabolism Vol. 97; no. 12; pp. 4422 - 4428
• Main Authors: Seal, L. J., Franklin, S., Richards, C., Shishkareva, A., Sinclaire, C., Barrett, J.
• Format: Journal Article
• Language: English
• Published: Bethesda, MD Oxford University Press 01.12.2012; Endocrine Society
• Subjects: Adult; Antiandrogens; Biological and medical sciences; Biomarkers - analysis; Breast; Breast Implants - adverse effects; Breast Implants - statistics & numerical data; Breasts; Endocrine therapy; Endocrinopathies; Estradiol - analogs & derivatives; Estradiol - therapeutic use; Estrogens; Estrogens, Conjugated (USP) - therapeutic use; Ethinyl Estradiol - therapeutic use; Ethinylestradiol; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Gonadotropin-releasing hormone; Hormone Replacement Therapy - adverse effects; Hormone Replacement Therapy - methods; Humans; Male; Mammaplasty - adverse effects; Mammaplasty - utilization; Medical sciences; Middle Aged; Patient Preference - statistics & numerical data; Prognosis; Reconstructive surgery; Retrospective Studies; Sex Reassignment Procedures - adverse effects; Sex Reassignment Procedures - methods; Sex Reassignment Procedures - statistics & numerical data; Thromboembolism; Transgender Persons - statistics & numerical data; Transsexualism - diagnosis; Transsexualism - therapy; Treatment Outcome; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vertebrates: endocrinology; Obesity; Nutrition; Nutrition disorder; Biological marker; Metabolic diseases; Plasty; Treatment; Surgery; Secondary effect; Therapeutic protocol; Endocrinology; Nutritional status; Comparative study
• ISSN: 0021-972X; 1945-7197; 1945-7197
• DOI: 10.1210/jc.2012-2030

Context:Breast development in transwomen is an important issue, affecting general psychological functioning. Current hormonal therapies are imperfect, with 60% of patients requesting mammoplasty.Interventions:Interventions included the following: 1) comparing the effects on transwomen's requests for mammoplasty of estrogen valerate, ethinylestradiol, and conjugated equine estrogen (CEE) hormone treatments; and 2) comparing the effects of GnRH analogs and androgen antagonists.Objective:The objective of the study was to identify which hormone regimen is associated with the greatest subsequent request for augmentation mammoplasty.Design:The study was a controlled, retrospective case audit.Setting:The study was conducted at a single-center National Health Service tertiary care unit.Patients:Patients were eligible for breast augmentation after 2 yr of estrogen treatment, were Tanner IV or higher breast development, and reported psychological distress due to small breasts. One hundred sixty-five subjects and 165 age-matched controls were identified.Outcome Measure:The outcome measure was a mammoplasty request.Results:There were significantly more self-medicating individuals than controls in the mammoplasty group (11.5 vs. 6%, P < 0.05). The type of estrogen use did not affect the outcome. Compared with other antiandrogens, spironolactone use was significantly higher in those requesting mammoplasty (4.8 vs. 1.8%, P = 0.002). Thromboembolism occurred in 1.2% of individuals, more frequently in those treated with CEE than in those treated with either estrogen valerate or ethinylestradiol (4.4 vs. 0.6 vs. 0.7%, P = 0.026). Depression was noted in approximately 30% of individuals.Conclusions:Self-medication with estrogen is significantly more likely to result in a later request for mammoplasty than is treatment prescribed by licensed practitioners. Previous spironolactone use is more common in those requesting mammoplasty. CEE treatment is associated with a higher incidence of thromboembolism than treatment with other estrogen types.