Cyproterone Acetate Superfluous for HRT when Compared with Low-dose Estradiol:
This is a recent study. I am not sure how long it takes for them to circulate, but this study, if I read it correctly, is another reason to avoid CPA as it's extra feminizing aspects seem to be minimal while exposing a person to hepic and perhaps others sorts of harm:
This study is the first to evaluate the use of low doses of estrogens in TW. We have demonstrated that low estrogen doses alone or with CA are effective toward maintaining androgen suppression and serum E2 within the normal follicular-phase range.
Evaluations of the effects of low-dose estrogen therapy on physical changes, namely, breast development, facial hair growth, body hair growth and body fat redistribution, were not possible in our patient population because all of the patients reported prior use of other estrogen formulations without medical supervision for a variable period of time. However, the maintenance of estrogen levels in the normal female range suggests that low-dose estrogen therapy may be able to promote the satisfactory feminization of these patients. The facial hair response to hormonal treatment in transsexuals, even at high estrogen doses, is very poor and often requires complementary cosmetic treatments such as laser treatments and electrolysis. In addition, many signs of feminization, including breast development, depend on not only the estrogen dose but also the individual patient’s sensitivity to estrogen. In a cohort of transsexuals receiving
high doses of estrogen, the result of breast augmentation from hormones was described as modest, and the rate of breast augmentation surgery in a series of transsexuals was generally as high as 70% (
25-
27). Nevertheless, all patients in our cohort achieved an advanced Tanner’ stage (IV and V) in breast development.
OBJECTIVE: The ideal dosage of cross-sex hormones remains unknown. The aim of this study was to...
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METHODS:
The serum hormone and biochemical profiles of 51 transgender women were evaluated before gonadectomy. Hormone therapy consisted of conjugated equine estrogen alone or combined with cyproterone acetate. The daily dose of conjugated equine estrogen was 0.625 mg in 41 subjects and 1.25 mg in 10 subjects, and the daily dose of cyproterone acetate was 50 mg in 42 subjects and 100 mg in one subject.
RESULTS:
Estrogen-only therapy reduced the testosterone, luteinizing hormone and follicle-stimulating hormone levels from 731.5 to 18 ng/dL, 6.3 to 1.1 U/L and 9.6 to 1.5 U/L, respectively. Estrogen plus cyproterone acetate reduced the testosterone, luteinizing hormone and follicle-stimulating hormone levels from 750 to 21 ng/dL, 6.8 to 0.6 U/L and 10 to 1.0 U/L, respectively. The serum levels of luteinizing hormone, follicle-stimulating hormone, testosterone, estradiol and prolactin in the patients treated with estrogen alone and estrogen plus cyproterone acetate were not significantly different. The group receiving estrogen plus cyproterone acetate had significantly higher levels of gamma-glutamyltransferase than the group receiving estrogen alone. No significant differences in the other biochemical parameters were evident between the patients receiving estrogen alone and estrogen plus cyproterone acetate.
CONCLUSION:
In our sample of transgender women, lower estrogen doses than those usually prescribed for these subjects were able to adjust the testosterone and estradiol levels to the physiological female range, thus avoiding high estrogen doses and their multiple associated side effects.
In our sample of TW, lower estrogen doses than those usually prescribed for these subjects were able to adjust the T and E2 levels to the physiological female range, avoiding the risks of high estrogen doses. Both regimens, namely, CEE alone or with CA, achieved the laboratory goals in the treatment of TW.
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