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 reports on a 51-year-old transgender woman with refractory multifocal idiopathic localization-related epilepsy who initiated estradiol (E2) hormone therapy as part of gender-affirming hormone therapy (GAHT). Despite the known epileptogenic effects of estrogen, the patient started on a low-dose transdermal E2 patch, which was gradually increased. Over the course of a year, she experienced physical changes such as breast enlargement, softer skin, and less unwanted hair growth, with some fluctuations in seizure frequency. Her testosterone levels were significantly suppressed, and she expressed satisfaction with the reduction in gender dysphoria. The study emphasizes the importance of multidisciplinary care and careful monitoring when initiating GAHT in transgender patients with epilepsy, highlighting that the patient's epilepsy remained overall stable with continued management.

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