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Menstrual Suppression in Adolescent and Young Adult Transgender Males

Published:October 26, 2022DOI:https://doi.org/10.1016/j.jpag.2022.10.007

      Abstract

      Objective

      To describe time to cessation of menses in adolescent and young adult transgender males with testosterone and/or other hormonal therapies.

      Design

      Retrospective chart review.

      Setting

      Tertiary children's hospital.

      Participants

      Patients, aged 10-24, started on gender-affirming hormonal therapy between January 2013 to January 2019 (n = 220).

      Intervention(s)

      None.

      Main Outcome Measure(s)

      Time to cessation of menses.

      Results

      Most patients identified as transgender male or transmasculine (211/220, 95.9%) with an average age of 15.8 (±1.9) years. Approximately 53.6% (118/220) of patients reported regular menstrual cycles; 18.2% (40/220) reported irregular cycles. Median time to cessation of menses for all patients was 182 days. Patients treated with testosterone alone (n = 105), reported a median time to cessation of menses of 151 days. Patients started concurrently on testosterone and norethindrone acetate (NETA) (n = 5) had a median time to cessation of menses of 188 days, compared to 168 days for those on testosterone and depot medroxyprogesterone acetate (DMPA, n = 15). In 15 patients started on testosterone, a progestin therapy was later added to induce menstrual suppression and the median time to cessation of menses was 168 days (+DMPA, n = 4) or 56 days (+norethindrone acetate, n = 11). Patients treated with NETA (n = 14) or depot leuprolide (n = 11) reported a median time to cessation of menses of 78 days or 77 days, respectively. Considerable variability in prescribing patterns was noted in the remaining 36.4% patients (n = 80).

      Conclusion

      Patients used a variety of different hormonal regimens for menstrual suppression. Less than half achieve cessation of menses within six months. Norethindrone acetate and depot leuprolide users reported the most rapid cessation of menses.

      Keywords

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