Cerebrovascular occlusion in a transsexual man taking mestranol

The Collaborative Study Group for the Study of Stroke in Young Women studied 598 women from age 15 to 44 years with cerebrovascular disease. They found that the use of oral contraceptives was significantly more prevalent in women who had suffered a thrombotic stroke than in women who had not had strokes. The risk of thrombotic stroke was estimated to be nine times greater in users of oral contraceptives than in nonusers. We report a case in which a previously healthy man who was using an oral contraceptive drug developed middle cerebral artery occlusion. In the absence of other predisposing factors in this case, it appears that the cerebrovascular occlusion was related to estrogen administration. The occurrence of persistent severe headaches in patients using estrogenic hormones may be a clue to impending cerebrovascular occlusion.