Progestogen Use in Gender-Affirming Hormone Therapy: A Systematic Review

Area of Science:

• Endocrinology
• Reproductive Health
• Transgender Health

Background:

• Gender-affirming hormone therapy (GAHT) is crucial for transgender women's well-being.
• GAHT typically involves estrogen and testosterone-lowering agents.
• The role of progestogens in GAHT for transgender women is debated due to uncertain benefits and potential harms.

Approach:

• A systematic review adhering to PRISMA guidelines was performed.
• Searched 4 databases (PubMed/MEDLINE, Ovid, Cochrane) for studies from January 2000 to March 2022.
• Evaluated progestogen effects on breast development, cardiovascular disease, bone density, quality of life, and stroke incidence in transgender women over 16.

Key Points:

• Ten articles met inclusion criteria; studies with cyproterone acetate and comparator groups were included.
• No studies specifically assessed stroke incidence related to progestogen use in transgender populations.
• Progestogen use was linked to decreased high-density lipoprotein levels and increased thromboembolism risk.

Conclusions:

• Progestogen use in transgender women on GAHT showed a negative impact on lipid profiles and increased thromboembolism risk.
• No conclusive evidence supports progestogens improving quality of life or breast development in this population.
• Further research is essential to clarify the role and safety of progestogens in transgender women's GAHT.