Prolactinoma Resection in a Transgender Woman on Gender-affirming Hormone Therapy

The management of prolactinoma in the setting of gender-affirming hormone therapy (GAHT) is lacking in the literature. We present the case of a transgender woman who was found to have prolactinoma prior to initiating GAHT. Initially, medication effectively managed prolactin levels; however, upon starting GAHT, maintaining control of these levels became challenging. Opting to sustain GAHT without disruption and gain control over symptomatic hyperprolactinemia, the patient underwent endoscopic endonasal surgery, resulting in gross total tumor resection including the medial wall of the cavernous sinus. Postoperative assessments revealed normal prolactin levels without dopamine agonist medication, allowing uninterrupted continuation of GAHT; in the following months, prolactin has minimally increased with plans for monitoring without treatment for now due to intolerance of oral antidopaminergics and lack of visible lesion on follow-up magnetic resonance imaging.