Cerebral Venous Sinus Thrombosis Associated With Testosterone Use as Gender-Affirming Hormone Therapy in a Transgender Patient: Case Report and Literature Review.

Transgender and gender-expansive (TG) people frequently experience gender dysphoria, which is associated with negative mental health. The use of gender-affirming hormone therapy (GAHT) is an important strategy in the management of this population. However, this therapy, especially with the use of testosterone, is associated with a variable risk of erythrocytosis and thus increased risk of thrombotic events. A 27-year-old patient, identifying as male trans non-binary, with a history of borderline personality disorder and gender dysphoria, started receiving testosterone undecanoate as gender-affirming hormone therapy (GAHT). Approximately 6 months after therapy was started, the patient presented complaints of miodesopsias and headache, with an eye fundus finding of bilateral papilledema. They (pronoun used for inclusive language) were referred to the emergency department where a brain CT angiography was performed, reporting bilateral transverse and sigmoid venous sinus thrombosis. Anticoagulation therapy was initiated with complete resolution of the obstruction. This case exemplifies a rare clinical association of a cerebral thrombotic event associated with testosterone as gender-affirming hormone therapy in a transgender patient. Thromboembolic events are a serious complication associated with hormone therapy, particularly in the transgender population in which this strategy is one of the fundamental pillars for management. Although thrombosis associated with the use of estrogens and progesterone is well described, there is scarce evidence regarding the relationship with the use of testosterone.