Progestogen Use in Gender Affirming Hormone Therapy: A Systematic Review

Elsevier

Available online 23 August 2022

Endocrine PracticeHighlights•

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.

Objective

Transgender 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.

Methods

A 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.

Results

Ten 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.

Conclusion

Overall, 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.

Keywords

Progesterone

progestin

micronized progesterone

medroxyprogesterone acetate

cyproterone acetate

transgender

gender identity

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© 2022 Published by Elsevier Inc. on behalf of the AACE.

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