Medroxyprogesterone acetate treatment significantly reduces testosterone level with few side effects and no change in estradiol levels, according to study results published in the Journal of Clinical Endocrinology & Metabolism.

Medroxyprogesterone acetate is a commonly used feminizing gender-affirming hormone treatment, but data are lacking for its use in the context of transgender care. To evaluate the efficacy and safety of medroxyprogesterone acetate in transwomen, researchers conducted a retrospective study of patients (N = 92) who underwent feminizing hormone therapy at Rhode Island Hospital between January 2011 and July 2018.

Across 290 total follow-up visits, 39 patients received a regimen of estradiol and spironolactone plus medroxyprogesterone acetate and 53 received only estradiol and spironolactone. The average age of patients at baseline was 31 years and average duration of therapy was 3.4 years.

The researchers found no significant between-group difference in estradiol levels. The group who did not receive medroxyprogesterone acetate had a mean weighted level of 210 pg/mL for serum estradiol, and the medroxyprogesterone acetate group had a mean weighted level of 211 pg/mL (P =.886). The investigators did, however, discover that reductions in testosterone were significantly greater following treatment in the medroxyprogesterone acetate group than in the group who received only estradiol and spironolactone (mean weighted level, 79 ng/dL vs 215 ng/dL, respectively; P <.001).

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Of the patients who received medroxyprogesterone acetate, 67% reported improved breast development and 28% reported decreased facial hair. In addition, mood swings were reported in 13% of the medroxyprogesterone acetate. Otherwise, no other significant side effects were reported.

Several limitations were noted for this study, including potential underestimation of incidence of side effects and varying doses of medroxyprogesterone acetate in patients included in the study.

“We found minimal side effects associated with [medroxyprogesterone acetate] treatment, unchanged estradiol levels, lower testosterone, and minimal changes in other biochemical parameters,” the researchers said. “Future studies should be conducted to confirm our findings, systematically assess the safety of [medroxyprogesterone acetate], and further investigate the effects of [medroxyprogesterone acetate] in transgender persons.”

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Reference

Jain J, Kwan D, Forcier M. Medroxyprogesterone acetate in gender-affirming therapy for transwomen: Results from a retrospective study [published online April 25, 2019]. J Clin Endocrinol Metab. doi:10.1210/jc.2018-02253