Anterior Extra-Dural Clinoidectomy in the Approach to Supratentorial Skull Base Meningiomas: A Series of 142 Cases

In a retrospective analysis of 27 late-pubertal transgender female adolescents, cyproterone acetate (CA) was used as an antiandrogenic progestin monotherapy for an average of 12 months, followed by a combination with incremental doses of estrogens (CA + E) for an average of 16 months. The study observed physical changes such as decreased facial and non-facial hair growth, and one third of the participants experienced breast development (Tanner stages B2–B3) on CA alone, which increased during CA + E treatment. Side effects reported included breast tenderness, emotionality, fatigue, and flushes, but no significant weight changes. Safety parameters indicated decreases in hemoglobin and hematocrit, transient increases in liver enzymes during CA, and slight decreases in triglycerides and cholesterol levels that returned to baseline during CA + E treatment. Gonadotropins decreased and testosterone levels dropped throughout the treatment, while prolactin levels increased with CA and normalized with CA + E. The study concluded that CA is a safe and well-tolerated treatment that induces mild feminizing effects and can be a valuable alternative when gonadotropin-releasing hormone analogues are not an option. Rapid feminization was observed with the addition of estrogens. However, the study's limitations include its modest sample size and retrospective nature.