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Dorte Glintborg, Katrine Hass Rubin, Simon Bang Mohr Kristensen, Øjvind Lidegaard, Guy T’Sjoen, Aisa Burgwal, Malene Hilden, and Marianne Skovsager Andersen

correspond to 50,000 Danish individuals in a total population of 5.8 million inhabitants. In Denmark, assessment and medical or surgical treatment of adult transgender persons take place at three centres located in Copenhagen, Odense, and Aalborg. Persons

Open access

Lachlan Angus, Shalem Leemaqz, Olivia Ooi, Pauline Cundill, Nicholas Silberstein, Peter Locke, Jeffrey D Zajac, and Ada S Cheung


Oestradiol with or without an anti-androgen (cyproterone acetate or spironolactone) is commonly prescribed in transfeminine individuals who have not had orchidectomy; however, there is no evidence to guide optimal treatment choice.


We aimed to compare add-on cyproterone acetate versus spironolactone in lowering endogenous testosterone concentrations in transfeminine individuals.


Retrospective cross-sectional study.


We analysed 114 transfeminine individuals who had been on oestradiol therapy for >6 months in two gender clinics in Melbourne, Australia. Total testosterone concentrations were compared between three groups; oestradiol alone (n = 21), oestradiol plus cyproterone acetate (n = 21) and oestradiol plus spironolactone (n = 38). Secondary outcomes included serum oestradiol concentration, oestradiol valerate dose, blood pressure, serum potassium, urea and creatinine.


Median age was 27.0 years (22.5–45.1) and median duration of hormone therapy was 1.5 years (0.9–2.6), which was not different between groups. On univariate analysis, the cyproterone group had significantly lower total testosterone concentrations (0.8 nmol/L (0.6–1.20)) compared with the spironolactone group (2.0 nmol/L (0.9–9.4), P = 0.037) and oestradiol alone group (10.5 nmol/L (4.9–17.2), P < 0.001), which remained significant (P = 0.005) after adjustments for oestradiol concentration, dose and age. Serum urea was higher in the spironolactone group compared with the cyproterone group. No differences were observed in total daily oestradiol dose, blood pressure, serum oestradiol, potassium or creatinine.


The cyproterone group achieved serum total testosterone concentrations in the female reference range. As spironolactone may cause feminisation without inhibition of steroidogenesis, it is unclear which anti-androgen is more effective at feminisation. Further prospective studies are required.

Open access

Simon Chang, Christian Fynbo Christiansen, Anders Bojesen, Svend Juul, Anna-Marie B Münster, and Claus H Gravholt

-to-male transgender persons ( 28 ). In that study, adjusted rates of VTE or ATE were not different among 2118 testosterone-treated genetic females compared with reference men or women. Men with KS on testosterone treatment presenting with thrombosis did not commonly

Open access

Agnieszka Pazderska, Yaasir Mamoojee, Satish Artham, Margaret Miller, Stephen G Ball, Tim Cheetham, and Richard Quinton

’Endocrinologie et de Nutrition 1973 16 179 – 199 . 4147392 11 Gooren LJ. Management of female-to-male transgender persons: medical and surgical management, life expectancy . Current Opinion in Endocrinology, Diabetes and Obesity 2014 21 233 – 238