Available online 23 August 2022
Highlights•Progestogens such as progesterone as part of gender affirming hormone therapy for transgender women is often requested for increased breast development and improved quality of life.
•The currently published literature provides no clinical evidence that progestogen improves breast development or quality of life in transgender women.
•Studies reviewed show that progestogens use has been associated with decreased HDL levels and increased risk of thromboembolism in transgender women.
•More research needs to be conducted regarding progestogens use in transgender women.
ObjectiveTransgender women take gender affirming hormone therapy (GAHT) to affirm their gender identity and improve quality of life and well-being. Usually, GAHT in transgender women consists of estrogen plus a testosterone lowering medication. The use of progestogens in GAHT for transgender women has been a controversial topic due to lack of evidence for benefit and potential for increased harm.
MethodsA systematic review was conducted based on the PRISMA guidelines using 4 databases (PubMed/MEDLINE, Ovid, Cochrane). Manuscripts were reviewed from January 2000 to March 2022 to identify effects of progestogens in transgender women over the age of 16 on breast development, cardiovascular disease, bone density, quality of life, and stroke incidence.
ResultsTen articles were deemed eligible based on specific inclusion and exclusion criteria. Studies analyzing users of cyproterone acetate were also included if there was a comparator group. No relevant studies were found assessing stroke incidence in the transgender population using a progestogen compound.
ConclusionOverall, findings were significant for decreased HDL level and increased thromboembolism in transgender women using progestogens. No conclusive evidence was found regarding improved quality of life or breast development. Further research needs to be conducted assessing the effects of progestogens in transgender women.
KeywordsProgesterone
progestin
micronized progesterone
medroxyprogesterone acetate
cyproterone acetate
transgender
gender identity
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