84. Menstrual suppression in adolescent and young adult transgender males

Abstract

<h3>Background</h3> Menstrual bleeding can worsen gender dysphoria in transgender males. Gender affirming hormone therapy with testosterone has been shown to induce amenorrhea in the majority of adult patients within 6 months. Little is known about the effects of testosterone with adjunctive menstrual suppression agents in adolescents and young adults. The objective of our study was to describe time to cessation of menses in transgender males with testosterone and/or other hormonal therapies. <h3>Methods</h3> An IRB-approved chart review was performed on patients with a female sex assigned at birth ages 10-24 with ICD-10 codes for gender dysphoria started on hormonal therapy from January 1, 2013 to January 1, 2019. Primary outcome was time to cessation of menses. Deidentified demographic, clinical, and prescription data was abstracted. IBM SPSS v 27 was used to compute descriptive statistics and Kaplan-Meier survival to estimate median time to amenorrhea. <h3>Results</h3> 256 patients were included in the study and the mean age was 15.8 (±1.9) years. The majority (95.7%) identified as transgender male or transmasculine. Almost half of patients (46.5%) reported monthly periods and 16.4 % had irregular periods. Patients that were amenorrheic (12.1%) or who received no treatment (2.0%) were excluded from further analysis. In the remaining 220 patients, the median time to cessation of menses was 182 days. 140 (63.6%) patients started testosterone without prior menstrual management. For those patients treated with testosterone alone (n = 105), the median time to cessation of menses was 151 days. Patients started on testosterone with norethindrone acetate (n=5) had a median time to amenorrhea of 188 days compared to 168 days for those starting on testosterone and depot medroxyprogesterone acetate (DMPA, n=15). 18 patients were started on a progestin therapy after initiation of testosterone to induce menstrual suppression. The median time to amenorrhea from addition of DMPA (n=4) was 168 days compared to 56 days when norethindrone acetate was added (n=11). See Table 1 and Figure 1. For the remaining 36.4% (n = 80) of patients, considerable variability in prescribing patterns was noted. <h3>Conclusions</h3> The majority of patients starting testosterone for gender dysphoria have menstrual bleeding. Unlike adult studies, less than half of patients starting testosterone achieve amenorrhea within 6 months. For patients not satisfied with menstrual control, there appears to be a wide variety of practice patterns, with some suggestion that norethindrone acetate may achieve amenorrhea quicker than DMPA. Prospective studies are needed to determine if this difference is significant and provide guidance to providers on the optimal hormonal regimen.