Progestogen Experience Among Transgender Women and Gender Diverse Adults Assigned Male at Birth in the United States.

Objectives: Progestogens are often sought as part of estrogen-based gender-affirming hormone therapy (E-GAHT) in transgender and gender diverse (TGD) adults assigned male sex at birth (AMAB). Few studies describe their use or impact. The purpose of this study is to describe and evaluate the patient experience with progestogens for E-GAHT.

Methods: Through a cross-sectional, mixed-methods concurrent embedded design study, an online cohort of TGD AMAB adults with feminine/transfeminine or non-binary gender identity in the United States was surveyed about progestogen use patterns, initiation reasons, perceived impact of progestogens, side effects, and care satisfaction.

Results: 543 participants completed the study. Among 310 progestogen users, the most common progestogens were oral micronized progesterone (58.4%), rectal micronized progesterone (10.6%), and oral medroxyprogesterone acetate (7.7%). Breast development (85.2%) was the most cited reason for progestogen initiation. Most progestogen users perceived improvement in breast development (79.6%) and sense of femininity (81.3%). Fewer participants reported changes in libido, sleep, and memory. Common side effects were breast pain (28.7%) and mood fluctuation (21.9%). Cases of lower extremity venous thrombosis (n=6), pulmonary embolism (n=4), and stroke (n=4) were reported. Most users expressed satisfaction with progestogens (71.9%) but also reported barriers and lack of clarity surrounding effectiveness or whether to initiate.

Conclusions: In the largest survey describing progestogen experience in E-GAHT to date, over half of TGD AMAB adults used progestogens. While most report satisfaction with use, further objective evidence on the benefits of progestogens is needed to clarify its clinical impact as part of E-GAHT.