SUN-144: Initiating Estradiol Hormone Therapy in a Transgender Woman With Multifocal Idiopathic Localization-Related Epilepsy

October 2025 in “ Journal of the Endocrine Society ”

Twan Sia, Julia Chang

estradiol transdermal estradiol estrogen progesterone hormone therapy gender dysphoria breast enlargement reduced unwanted hair growth estrogen therapy hormone replacement therapy HRT

TLDR The patient was satisfied with hormone therapy, and her epilepsy remained stable.

This case study discusses the initiation of estradiol hormone therapy in a 51-year-old transgender woman with refractory multifocal idiopathic localization-related epilepsy. Despite the known epileptogenic effects of estrogen, the patient started low-dose transdermal estradiol to alleviate gender dysphoria, with careful monitoring of seizure activity. Over a year, the patient experienced physical changes such as breast enlargement and reduced unwanted hair growth, while her seizures persisted but did not worsen significantly. Adjustments to her antiepileptic medication and the addition of progesterone were made to manage her condition. The study emphasizes the importance of multidisciplinary care in managing hormone therapy for transgender patients with epilepsy, highlighting the patient's overall satisfaction with her gender-affirming hormone therapy and stable epilepsy management.

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