Toward a Lowest Effective Dose of Cyproterone Acetate in Trans Women: Results From the ENIGI Study.
Androgen Antagonists
/ administration & dosage
Belgium
Cohort Studies
Cyproterone Acetate
/ administration & dosage
Dose-Response Relationship, Drug
Female
Gender Dysphoria
/ drug therapy
Gender Identity
Hormone Replacement Therapy
/ adverse effects
Humans
Italy
Longitudinal Studies
Male
Netherlands
Sex Reassignment Procedures
/ adverse effects
Transsexualism
/ drug therapy
Treatment Outcome
anti-androgen
cyproterone acetate
hormone therapy
testosterone
trans people
Journal
The Journal of clinical endocrinology and metabolism
ISSN: 1945-7197
Titre abrégé: J Clin Endocrinol Metab
Pays: United States
ID NLM: 0375362
Informations de publication
Date de publication:
27 09 2021
27 09 2021
Historique:
received:
01
03
2021
pubmed:
15
6
2021
medline:
15
12
2021
entrez:
14
6
2021
Statut:
ppublish
Résumé
Cyproterone acetate (CPA) is a competitive inhibitor of the androgen receptor and exerts negative hypothalamic feedback. It is often used in combination with estrogens in trans women to achieve feminization. However, CPA has been associated with side effects such as changes in liver enzyme concentrations and increases in prolactin concentrations. The question is whether the testosterone-lowering effect, as well as these side effects, are dose dependent. To assess the lowest effective dose of CPA in trans women to prevent side effects. This longitudinal study, conducted at gender identity centers in Amsterdam, Ghent, and Florence, is part of the European Network for the Investigation of Gender Incongruence (ENIGI), a multicenter prospective cohort study. Participants were trans women (n = 882) using estrogens only or in combination with 10, 25, 50, or 100 mg CPA daily. The primary outcome measure was the concentration of testosterone at 3 and/or 12 months of hormone therapy. Using estrogens only (without CPA) led to testosterone concentrations of 5.5 nmol/L (standard error of the mean [SEM] 0.3). All doses of CPA resulted in testosterone concentrations below the predefined threshold of suppression of 2 nmol/L (10 mg, 0.9 nmol/L, SEM 0.7; 25 mg, 0.9 nmol/L, SEM 0.1; 50mg, 1.1 nmol/L, SEM 0.1; 100 mg, 0.9 nmol/L, SEM 0.7). Higher prolactin and lower high-density lipoprotein concentrations were observed with increasing doses of CPA. No differences in liver enzyme concentrations were found between the doses. Compared with higher doses of CPA, a daily dose of 10 mg is equally effective in lowering testosterone concentrations in trans women, while showing fewer side effects.
Identifiants
pubmed: 34125226
pii: 6298578
doi: 10.1210/clinem/dgab427
pmc: PMC8571811
doi:
Substances chimiques
Androgen Antagonists
0
Cyproterone Acetate
4KM2BN5JHF
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
e3936-e3945Commentaires et corrections
Type : CommentIn
Informations de copyright
© The Author(s) 2021. Published by Oxford University Press on behalf of the Endocrine Society.
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