Endocrine Abstracts

JOINT2045

Introduction: Primary ovarian insufficiency (POI) complicates gender-affirming hormone therapy in non-binary individuals. Testosterone therapy, while effective for masculinization, may exacerbate POI-associated risks such as osteoporosis, cardiovascular disease, and endometrial hyperplasia. This case explores the challenges of testosterone therapy in a non-binary individual with cervical cancer and radiotherapy-induced POI.

Case Report: A 28-year-old non-binary individual (preferred pronouns: they/them) presented with severe hypothyroidism (Free T4 < 2.0 pmol/l, TSH > 100 mu/l)due to Hashimoto’s thyroiditis, alongside fatigue, cognitive slowing, and paresthesia. Levothyroxine improved symptoms. The patient had a history of cervical cancer (FIGO Stage III) treated with surgery, chemotherapy, and radiotherapy, likely inducing POI (FSH 113.2 iu/l, LH 68.1 iu/l, Oestradiol < 100 pmol/L). They had previously used testosterone for gender dysphoria but discontinued it due to cancer treatment. The patient had mental health conditions, including bipolar disorder, anxiety, and depression, aggravated by past trauma. They were uncertain about restarting testosterone therapy due to long-term health concerns. Options included testosterone for masculinisation or estrogen/progesterone for symptoms and bone protection. The patient decided to address thyroid health first and was referred to a London gender reassignment clinic.

Discussion: Testosterone therapy in non-binary individuals with POI presents a clinical dilemma. While it alleviates gender dysphoria and induces masculinization, POI increases risks of osteoporosis and cardiovascular disease due to estrogen deficiency. Testosterone may not provide equivalent skeletal or cardiovascular protection, and endometrial hyperplasia remains a concern in individuals with an intact uterus. This case highlights the need for individualized, multidisciplinary care. Shared decision-making is critical, particularly in the context of prior malignancy and complex mental health histories. Further research is needed to establish guidelines for testosterone use in non-binary individuals with POI.

Conclusion: Testosterone therapy in non-binary individuals with POI requires careful consideration of risks and benefits. While beneficial for gender affirmation, its potential harms in POI must be weighed against the individual’s health status and goals. This case underscores the need for evidence-based guidelines to optimize care for this population.

References: 1. Hembree, W. C., et al. (2017). Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons. JCEM, 102(11), 3869–3903.

2. Wiik, A., et al. (2020). Hormonal and Skeletal Effects of Testosterone Therapy in Transgender Men. JCEM, 105(3), e1–e13.

3. Prior, J. C. (2018). Progesterone for Osteoporosis in Women. Climacteric, 21(4), 366–374.