Lachlan M Angus,Shalem Y Leemaqz,Anna K Kasielska-Trojan,Maksym Mikołajczyk,James C G Doery,Jeffrey D Zajac,Ada S Cheung
{"title":"Effect of spironolactone and cyproterone acetate on breast growth in transgender people: a randomized clinical trial.","authors":"Lachlan M Angus,Shalem Y Leemaqz,Anna K Kasielska-Trojan,Maksym Mikołajczyk,James C G Doery,Jeffrey D Zajac,Ada S Cheung","doi":"10.1210/clinem/dgae650","DOIUrl":null,"url":null,"abstract":"CONTEXT\r\nTransgender people with sex recorded male at birth desiring feminization commonly use cyproterone acetate or spironolactone as anti-androgens with estradiol, but the optimal anti-androgen is unclear.\r\n\r\nOBJECTIVE\r\nTo assess the effect of anti-androgens on breast development. We hypothesized this would be greater in those treated with cyproterone acetate than spironolactone due to more potent androgen receptor antagonism and suppression of serum total testosterone concentrations.\r\n\r\nDESIGN\r\nRandomised clinical trial 2020-2022.\r\n\r\nSETTING\r\nOutpatient endocrinology clinic.\r\n\r\nPARTICIPANTS\r\nTransgender people aged 18+ years old commencing feminizing gender affirming hormone therapy.\r\n\r\nINTERVENTIONS\r\nStandardized estradiol therapy plus either spironolactone 100mg daily or cyproterone acetate 12.5mg daily for six months.\r\n\r\nMAIN OUTCOME MEASURES\r\nPrimary outcome was breast development as measured by the breast chest distance. Secondary outcomes included estimated breast volume, suppression of serum total testosterone concentration <2nmol/L and Gender Preoccupation and Stability Questionnaire (GPSQ).\r\n\r\nRESULTS\r\nSixty-three people (median age 25 years) were enrolled, randomized and included in intention-to-treat analysis (cyproterone acetate n=32, spironolactone n=31). At six months, there was no between-group difference in breast chest distance (mean difference 0.27 cm, 95% CI -0.82 to 1.35, p=0.6) or estimated breast volume (mean difference 17.26 mL, 95% CI -16.94 to 51.47, p=0.3). Cyproterone acetate was more likely to suppress serum testosterone concentration to <2 nmol/L (odds ratio 9.01, 95% CI 1.83 to 4.44, p=0.008). Changes in GPSQ were similar between groups.\r\n\r\nCONCLUSION\r\nAnti-androgen choice should be based on clinician and patient preference with consideration of side effects. Further research is needed to optimize breast development in transgender people.","PeriodicalId":22632,"journal":{"name":"The Journal of Clinical Endocrinology & Metabolism","volume":"43 1","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"The Journal of Clinical Endocrinology & Metabolism","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1210/clinem/dgae650","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
Abstract
CONTEXT
Transgender people with sex recorded male at birth desiring feminization commonly use cyproterone acetate or spironolactone as anti-androgens with estradiol, but the optimal anti-androgen is unclear.
OBJECTIVE
To assess the effect of anti-androgens on breast development. We hypothesized this would be greater in those treated with cyproterone acetate than spironolactone due to more potent androgen receptor antagonism and suppression of serum total testosterone concentrations.
DESIGN
Randomised clinical trial 2020-2022.
SETTING
Outpatient endocrinology clinic.
PARTICIPANTS
Transgender people aged 18+ years old commencing feminizing gender affirming hormone therapy.
INTERVENTIONS
Standardized estradiol therapy plus either spironolactone 100mg daily or cyproterone acetate 12.5mg daily for six months.
MAIN OUTCOME MEASURES
Primary outcome was breast development as measured by the breast chest distance. Secondary outcomes included estimated breast volume, suppression of serum total testosterone concentration <2nmol/L and Gender Preoccupation and Stability Questionnaire (GPSQ).
RESULTS
Sixty-three people (median age 25 years) were enrolled, randomized and included in intention-to-treat analysis (cyproterone acetate n=32, spironolactone n=31). At six months, there was no between-group difference in breast chest distance (mean difference 0.27 cm, 95% CI -0.82 to 1.35, p=0.6) or estimated breast volume (mean difference 17.26 mL, 95% CI -16.94 to 51.47, p=0.3). Cyproterone acetate was more likely to suppress serum testosterone concentration to <2 nmol/L (odds ratio 9.01, 95% CI 1.83 to 4.44, p=0.008). Changes in GPSQ were similar between groups.
CONCLUSION
Anti-androgen choice should be based on clinician and patient preference with consideration of side effects. Further research is needed to optimize breast development in transgender people.