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. (J Clin Endocrinol Metab 97: 4422-4428, 2012)