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(11) ATYPICAL PRESENTATIONS AND RESPONSES TO CROSS HORMONAL THERAPY IN TRANSGENDER PATIENTS


Authors:

Sérgio Andrade – medico, md

Elba Bandeira, MD, MSc – consultant endocrinologist, Hospital Agamenon Magalhães

Francisco Bandeira – MEDICO, MD, PhD

Sérgio Andrade – medico, md

Abstract:

Objective : To describe atypical presentations and follow-up of transgender men and women in situations of cross-hormonal therapy followed at a specialized outpatient clinic.

Methods :

This is a series of cases, which was performed through the data base analysis from transgender patients attending our endocrine outpatient clinic. The study was approved by Institutional Ethics in Research Committee.

Results : Case #1: A 29-year-old transgender woman presented with normal bone density and absence of fractures ten years after surgical castration induced by sexual affirming surgery. Case #2: Diffuse scaling erythroderma in use of testosterone cypionate in transgender man. Case #3: False elevation of lean mass at full-body densitometry in a transgender woman. Case #4: Evidence of gender incongruity during investigation for high statured in prepubertal male. Case #5: Induced cross-puberty in a transgender boy 10 years of age due to severe gender dysphoria.

Discussion : Case #1: Possible mechanisms such as initial exposure to testosterone until the age of 19 by natural puberty followed by 9 years of high-dose oral estradiol may well be resulted in residual bone effect. Case #2: This case has an uncertain pathophysiology. Case #3: False elevation of lean mass probably by inflammatory reaction and fibrosis between adjacent tissues and the surface of the silicone prosthesis in the hip and buttocks, facilitating the passage of Xrays and overestimating lean mass. Case #4: The pacient rejected the use of testosterone to close the epiphyseal cartilage and initiated the use of high doses of estrogen and antiandrogen. Case #5: This case showed the preservation of bone age and mental health.

Conclusion :

Our cases illustrate unusual presentations and hormonal responses in transgender patients. The study of atypical clinical presentation and follow-up in transgender patients in situations of cross-hormonal therapy is a new and fascinated area in the field of endocrinology with so much to be scientifically explored.

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