Prudent Management of Microprolactinoma in a Transgender Woman on Feminizing Hormonal Therapy
https://doi.org/10.15605/jafes.041.S1
- Author:
Zi Yang Lian
1
;
Nicholas Ken Yoong Hee
2
;
Shireene Vethakkan
1
;
Jeyakantha Ratnasingam
1
Author Information
1. Endocrine Unit, Department of Medicine, Faculty of Medicine, Universiti Malaya
2. Endocrine Unit, Department of Medicine, Universiti Malaya Medical Centre
- Publication Type:Journal Article
- MeSH:
Female;
Prolactinoma;
Transgender Persons
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):87-
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Gender-affirming hormone therapy (GAHT) for transgender women utilizes estrogen and an anti-androgen
like cyproterone acetate (CPA) which can both lead to
hyperprolactinemia. Although mild prolactin elevations
are common, the development of prolactinomas in transgender women on GAHT is rare.
Case:A 23-year-old trans-woman on self-purchased estradiol
hemihydrate (17β-estradiol) 4 mg and CPA 12.5 mg daily
for GAHT presented with galactorrhea. Investigations
revealed markedly elevated prolactin at 2,369 mIU/L and
elevated estradiol at 848 pmol/L. A pituitary magnetic
resonance imaging (MRI) identified a 0.4 × 0.5 cm microprolactinoma.
She declined clinical advice to reduce her medication dose
and continued on the same treatment. In the subsequent
year, her peak prolactin was 1,383 mIU/L, and a repeat
MRI showed the microprolactinoma remained stable. She
continues to be on close clinical monitoring.
Transgender females experience approximately a fourfold
higher rate of developing prolactinomas. The patient’s
choice to persist with GAHT reflects the challenges
in managing gender dysphoria alongside medical
complications. A recent paper by BJ Nolan et al. suggests
using prolactin levels exceeding 2,000–3,000 mIU/L to
guide further investigations including a pituitary MRI to rule out a prolactinoma. In most cases, the serum prolactin
levels will return to the normal range with a reduction or
discontinuation of the GAHT. Normalization of prolactin
levels have been reported after gonadectomy and CPA
cessation in transgender females on GAHT, which suggests
that CPA usage may be associated with higher risk of
hyperprolactinemia compared to estrogen therapy.
Conclusion:This case highlights that GAHT can lead to development of
prolactinomas. Prolactin monitoring and MRI investigations
should be reserved for symptomatic patients, and for
those with significantly elevated or increasing prolactin
levels. While treatment using dopamine agonists have
been reported, this case demonstrates that conservative
management and close monitoring can be a viable approach
for structurally stable microprolactinomas.
- Full text:2026080414330001595EP_A122.pdf
