Predictive markers for mammoplasty and a comparison of side effect profiles in transwomen taking various hormonal regimens.

CONTEXT: Breast development in transwomen is an important issue, affecting general psychological functioning. Current hormonal therapies are imperfect, with 60% of patients requesting mammoplasty.

INTERVENTIONS: Interventions included the following: 1) comparing the effects on transwomen's requests for mammoplasty of estrogen valerate, ethinylestradiol, and conjugated equine estrogen (CEE) hormone treatments; and 2) comparing the effects of GnRH analogs and androgen antagonists.

OBJECTIVE

The objective of the study was to identify which hormone regimen is associated with the greatest subsequent request for augmentation mammoplasty.

DESIGN

The study was a controlled, retrospective case audit.

SETTING

The study was conducted at a single-center National Health Service tertiary care unit.

PATIENTS: Patients were eligible for breast augmentation after 2 yr of estrogen treatment, were Tanner IV or higher breast development, and reported psychological distress due to small breasts. One hundred sixty-five subjects and 165 age-matched controls were identified.

OUTCOME MEASURE: The outcome measure was a mammoplasty request.

RESULTS

There were significantly more self-medicating individuals than controls in the mammoplasty group (11.5 vs. 6%, P < 0.05). The type of estrogen use did not affect the outcome. Compared with other antiandrogens, spironolactone use was significantly higher in those requesting mammoplasty (4.8 vs. 1.8%, P = 0.002). Thromboembolism occurred in 1.2% of individuals, more frequently in those treated with CEE than in those treated with either estrogen valerate or ethinylestradiol (4.4 vs. 0.6 vs. 0.7%, P = 0.026). Depression was noted in approximately 30% of individuals.

CONCLUSIONS

Self-medication with estrogen is significantly more likely to result in a later request for mammoplasty than is treatment prescribed by licensed practitioners. Previous spironolactone use is more common in those requesting mammoplasty. CEE treatment is associated with a higher incidence of thromboembolism than treatment with other estrogen types.