Severe Vasomotor Symptoms Post-Oophorectomy Despite Testosterone Therapy in a Transgender Man: A Unique Case Study

Vasomotor symptoms (VMS), such as hot flashes and night sweats, are intense and rapid sensations of internal heat, peripheral vasodilation, and profuse sweating that can be debilitating. They occur as a result of central norepinephrine discharge and narrowing of the core body thermoneutral zone with dropping brain estrogen levels in women and men. Therapy options for the treatment of VMS in postmenopausal women have been widely studied. However, we address treatment strategies for VMS that occur in some transgender men who have undergone oophorectomy. A 35-year-old female-to-male transgender man presented with symptoms of severe and frequent VMS that began shortly after total hysterectomy and oophorectomy. The patient was treated with a stable dose of testosterone for gender affirmation, and previous attempts to increase his testosterone dose did not relieve the VMS. In addition to his testosterone therapy, 0.025 to 0.0375 mg, twice per week, of transdermal estradiol was added to his hormonal regimen. Addition of estradiol completely relieved the VMS, and masculinization was not affected. Discontinuation of estradiol led to the recurrence of VMS at the same severity as previously experienced, which was associated with a low level of serum estrogen. VMS in a transgender man taking testosterone were successfully treated with the addition of transdermal estradiol.