S2989 Excessive Hormonal Therapy in a Male Transitioning to a Female Causing Cirrhosis

Abstract

Introduction: High doses of progestins/estrogens can cause elevated liver enzymes, serum aminotransferase elevations with no changes in alkaline phosphatase or bilirubin, 1 to 2 weeks after treatment. These side effects are usually transient and resolve with dose modification or discontinuation. We present a unique case where a male in-transition to female was found to be cirrhotic from hormonal dose therapy. Gastroenterologists should be aware of the importance of starting hormonal therapy in the transgender process as exogenous estrogen therapy may lead to underlying liver disease. Case Description/Methods: This is a 63 year male on hormone replacement therapy who presented to the hospital for evaluation of hyperlipidemia, hypertension, diabetes, and gender dysmorphia with concerns of questionable abdominal pain and early findings of cirrhosis. During evaluation, he complained of abdominal pain, jaundice, and dark urine. His LFTs were unremarkable prior to the visit. Upon inquiry of a prior history of fatty liver disease, he admitted not following up with his doctor. The patient then described how he had recently begun hormonal therapy to transition to a female. He reported first starting on an estrogen patch with a transition to estradiol 2mg daily. He denied having a prior history of alcohol abuse or other risk factors of cirrhosis. His liver function tests were noted to be T. Bili of 6.3, D. Bili of 3.2, ALK phos of 263, AST of 51, ALT of 176 and lipase of 100. Given his elevated LFTs an ultrasound and MRCP were performed which showed cirrhosis with portal hypertension and cholelithiasis. He did not have any synthetic liver dysfunction. Upon discontinuation of his estradiol his LFTS resolved back to baseline after five days. Discussion: Gastroenterologists should be aware of gender-affirming hormonal therapies in the transgender population as they can lead to long term sequale such as developing cirrhosis. Evidence in the literature is sparse with no consensus on the long term effects of high dose hormone therapy. Further studies should focus on the risk factors of starting hormonal therapy using demographic characteristics, BMI, and alcohol use as further parameters for gauging cirrhosis. We present the case of a 63-old trans-female patient whose hormone therapy can be associated directly with liver cirrhosis.