Menstrual Suppression in Adolescent and Young Adult Transgender Males

Objective: To describe time to cessation of menses in adolescent and young adult transgender males with testosterone and/or other hor-monal therapiesDesign: Retrospective chart reviewSetting: Tertiary children's hospitalParticipants: Patients, aged 10-24, who began gender-affirming hormonal therapy between January 2013 and January 2019 ( n = 220) Intervention(s): NoneMain Outcome Measure(s): Time to cessation of mensesResults: Most patients identified as transgender male or transmasculine (211/220, 95.9%), with an average age of 15.8 ( +/- 1.9) years. Approx-imately 53.6% (118/220) of patients reported regular menstrual cycles; 18.2% (40/220) reported irregular cycles. Median time to cessation of menses for all patients was 182 days. Patients treated with testosterone alone ( n = 105) reported a median time to cessation of menses of 151 days. Patients who concurrently began testosterone and norethindrone acetate (NETA) ( n = 5) had a median time to cessation of menses of 188 days, compared with 168 days for those on testosterone and depot medroxyprogesterone acetate (DMPA, n = 15). In 15 patients who began testosterone, a progestin therapy was later added to induce menstrual suppression, and the median time to cessation of menses was 168 days ( +DMPA, n = 4) or 56 days ( +NETA, n = 11). Patients treated with NETA ( n = 14) or depot leuprolide ( n = 11) reported a median time to cessation of menses of 78 days or 77 days, respectively. Considerable variability in prescribing patterns was noted in the remaining 36.4% of patients ( n = 80).Conclusion: Patients used a variety of different hormonal regimens for menstrual suppression. Less than half achieved cessation of menses within 6 months. NETA and depot leuprolide users reported the most rapid cessation of menses.