Endocrine Abstracts

JOINT455

An 18-year-old transfeminine youth presented with galactorrhea for two months, accompanied by intermittent headaches but no other neurological symptoms.

Medical History: The patient was diagnosed with HIV at 15 years of age and has been on antiretroviral therapy (atazanavir, ritonavir, abacavir/lamivudine). Laboratory results revealed a CD4 count of 654 cells/μL, CD4 percentage of 27%, and undetectable HIV viral load. She has a history of PTSD due to sexual assault and MDD, managed with escitalopram (10 mg/day) and trazodone (50 mg/day as needed).

Gender-Affirming Hormone History: At age 11, the patient began self-prescribing oral contraceptives (ethinyl estradiol 0.035 mg and cyproterone acetate 2 mg) based on a friend’s suggestion, using them inconsistently due to breast pain and financial limitations. Later, she purchased 17β-estradiol and cyproterone acetate online, following advice from a senior acquaintance, and intermittently used intramuscular hormones advertised online, including estradiol benzoate (3 mg) and progesterone (50 mg). She also performed regular self-breast massages for augmentation.

Clinical Findings: Physical examination showed bilateral breast engorgement and galactorrhea, with normal neurological findings. Laboratory results indicated elevated prolactin (261.5 ng/mL), estradiol (167.8 pg/mL), and low testosterone (0.429 nmol/l), with normal thyroid function. MRI revealed a pituitary microadenoma (3.5 × 2.7 × 2.6 mm) with a small cystic component.

Clinical Course: The patient was advised to discontinue injectable hormones, reduce estrogen doses, and stop breast massage. Despite this, she attended follow-ups irregularly and continued self-prescribed gender-affirming hormone therapy and breast massage against medical advice. Over time, her galactorrhea improved, with prolactin levels decreasing to 83.8 ng/mL at six months and normalizing after two years. Her headaches also resolved.

Conclusion: This case highlights the risks of self-prescribed hormone use in transfeminine youth, emphasizing the need for medical supervision to prevent endocrine complications. Accessible care and regular follow-up are crucial for safer outcomes.