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Updated: May 17, 2026
An Ex vivo Model to Study Hormone Action in the Human Breast
Published on: January 8, 2015
Predictive markers for mammoplasty and a comparison of side effect profiles in transwomen taking various hormonal
L J Seal1, S Franklin, C Richards
1St. George's Hospital Medical School, London SW17 0RE, United Kingdom. lseal@sgul.ac.uk
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.