ABSTRACT
Study Objective
Amenorrhea is a goal of many transgender and gender diverse adolescent and young adult
(TGD AYA) patients on testosterone gender-affirming hormone therapy (T-GAHT). Breakthrough
bleeding can contribute to worsening gender dysphoria. Our objective was to evaluate
breakthrough bleeding in TGD AYA on T-GAHT.
Design
Institutional review board−approved retrospective cohort.
Setting
Tertiary-care children's hospital.
Participants
TGD AYA on T-GAHT >1 year.
Interventions
None; observational.
Main Outcome Measures
Presence of, and risk factors for, breakthrough bleeding.
Results
Of the 232 patients who met inclusion criteria, one-fourth (n = 58) had 1 or more
episodes of breakthrough bleeding, defined as bleeding after more than 1 year on T-GAHT.
In comparing patients with breakthrough bleeding to those without, there were no significant
differences between age of initiation, body mass index (BMI), race/ethnicity, testosterone
type used, use of additional menstrual suppression, serum testosterone, or estradiol
levels. Patients with breakthrough bleeding patients were on T-GAHT longer (37.3 ±
17.0 vs 28.5 ± 14.6 months, P < .001) and were more likely to have endometriosis (P = .049). Breakthrough bleeding began at a mean of 24.3 ± 17.2 months after T-GAHT
initiation. Of those with breakthrough bleeding, 46 (79.3%) had no known cause, 10
(17.2%) bled only with missed T-GAHT doses, and 2 (3.4%) bled only when withdrawing
from concomitant menstrual suppression. No breakthrough bleeding management method
was found to be superior.
Conclusion
Breakthrough bleeding is relatively common (25%) on T-GAHT despite early amenorrhea.
Most cases do not have an identifiable cause. Our data did not show superiority of
any 1 method for managing breakthrough bleeding on T-GAHT.
Key Words
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Article info
Publication history
Published online: April 25, 2021
Accepted:
April 9,
2021
Received in revised form:
March 16,
2021
Received:
January 6,
2021
Footnotes
The authors report no financial conflicts of interest.
No funding was received for this work. Dr. Charlton was supported by grant MRSG CPHPS 130006 from the American Cancer Society.
Identification
Copyright
© 2021 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.
