Case 1: Clitoromegaly, Oligomenorrhea, and Hirsutism in a 17-Year-Old Transgender Male

September 2024 in “ Pediatrics in Review ”

Saira Ahmed, John M. Oberlin, Barbara Bowsher

clitoromegaly oligomenorrhea hirsutism hyperandrogenism testosterone androstenedione virilizing tumors nonclassical congenital adrenal hyperplasia gender-affirming hormone treatment GAHT

TLDR Parental support and gender-affirming care are crucial for the mental health of transgender adolescents.

A 17-year-old transgender male presented with clitoromegaly, oligomenorrhea, and hirsutism, showing signs of hyperandrogenism despite not receiving gender-affirming hormone treatment (GAHT) due to parental non-acceptance. Elevated testosterone and androstenedione levels were noted, and tests ruled out virilizing tumors and nonclassical congenital adrenal hyperplasia. The case highlights the importance of parental support and ethical considerations in providing GAHT to minors, advising the patient to seek GAHT from a qualified physician and wait until age 18 for further treatment. Gender-affirming care is crucial for improving mental health outcomes in gender-diverse adolescents.

View this study on publications.aap.org →

Discuss this study in the Community →

Research cited in this study

4 / 4 results

research Disorders of Sex Development

4 citations, August 2021 in “Pediatrics in review”

DSDs are birth conditions causing unusual sex development, managed with personalized care and sometimes surgery, but still lack a standard treatment approach.

research Polycystic Ovary Syndrome and NC-CAH: Distinct Characteristics and Common Findings. A Systematic Review

32 citations, June 2019 in “Frontiers in Endocrinology”

Polycystic Ovary Syndrome (PCOS) is common in women with conditions like anovulation, hirsutism, hair loss, and type 2 diabetes, and it can lead to health risks like heart disease, obesity, insulin resistance, and depression. Non-Classic Congenital Adrenal Hyperplasia (NC-CAH) is also discussed.

research Diagnosis and Treatment of Polycystic Ovary Syndrome: An Endocrine Society Clinical Practice Guideline

1265 citations, October 2013 in “The Journal of Clinical Endocrinology and Metabolism”

The guideline suggests using specific criteria to diagnose PCOS, recommends various treatments for its symptoms, and advises screening for related health issues.

A Prospective Study of the Prevalence of Nonclassical Congenital Adrenal Hyperplasia Among Women Presenting with Hyperandrogenic Symptoms and Signs

research A Prospective Study of the Prevalence of Nonclassical Congenital Adrenal Hyperplasia Among Women Presenting with Hyperandrogenic Symptoms and Signs

150 citations, November 2007 in “The Journal of Clinical Endocrinology and Metabolism”

About 2.2% of women with symptoms of high male hormones have a mild form of congenital adrenal hyperplasia, and measuring a specific hormone level can accurately diagnose it.

Similar Research

5 / 355 results

Non-Classic Congenital Adrenal Hyperplasia Due to 21-Hydroxylase Deficiency Revisited: An Update with a Special Focus on Adolescent and Adult Women

research Non-Classic Congenital Adrenal Hyperplasia Due to 21-Hydroxylase Deficiency Revisited: An Update with a Special Focus on Adolescent and Adult Women

117 citations, May 2017 in “Human Reproduction Update”

The update highlights that non-classic congenital adrenal hyperplasia is common in women with excess male hormones, requires specific hormone tests for diagnosis, and has various treatment options depending on age and symptoms.

Comparison of Clinical and Laboratory Characteristics of Cases with Polycystic Ovarian Syndrome Based on Rotterdam’s Criteria and Women with Only Oligo/Anovulation or Hirsutism

research Comparison of Clinical and Laboratory Characteristics of Cases with Polycystic Ovarian Syndrome Based on Rotterdam’s Criteria and Women with Only Oligo/Anovulation or Hirsutism

38 citations, May 2006 in “Archives of Gynecology and Obstetrics”

Women with only irregular periods or excess hair have a better hormone profile than those with full PCOS, but both groups are similar, indicating a need for better PCOS diagnosis methods.

research Polycystic Ovary Syndrome and the Differential Diagnosis of Hyperandrogenism

19 citations, July 2013 in “The obstetrician & gynaecologist”

The document concludes that careful evaluation is needed to diagnose PCOS correctly due to similar symptoms in other conditions, and accurate testosterone level measurement is crucial.

research Correlation of Clinical and Biochemical Hyperandrogenism in Thai Women with Polycystic Ovary Syndrome

14 citations, February 2016 in “Journal of Obstetrics and Gynaecology Research”

Blood tests are needed to confirm high male hormone levels in women with PCOS, as physical signs alone are not reliable.

research Is There Any Association Between Clinical and Biochemical Hyperandrogenism in Women With Female Pattern Hair Loss?

1 citations, November 2020 in “Cureus”

Clinical signs of hyperandrogenism are related to female pattern hair loss severity, but biochemical markers are not.