Endocrine Abstracts

Introduction: Testosterone treatment in female-to-male transsexuals has been associated with worsened cardiovascular risk factors, acne, male-pattern baldness and more rarely with the onset of hypertension. Another frequent side effect of the treatment is aggression proneness -but rarely actual aggression- and increased libido.

Case report: We present the case of a 17-year old transsexual patient referred for initiation of testosterone treatment. A low initial dose (20 mg daily as a topical gel) elicited acne and mild transient mood changes (increased libido, occasional aggressive ideation) without blood pressure elevation. These symptoms improved after the first month. Three months later, after increasing the dose to 40 mg, the patient presented bouts of anger, aggression proneness, and coincidentally headache and hypertensive episodes. Secondary hypertension was ruled out and an ambulatory blood pressure monitoring showed blood pressure peaks up to 192/113 mmHg, with tachycardia up to 123 bpm and a mean activity blood pressure of 138/87 mm Hg. The patient was diagnosed of adjustment disorder, received short-course psychotherapy and testosterone was withdrawn. After one month, the mood disorder had abated, without new episodes of headache and hypertension. A second ambulatory blood pressure monitoring showed no hypertensive peaks with a mean activity blood pressure of 124/71 mmHg. According to the patient’s wishes, low-dose testosterone treatment was reinstated with a scheduled slow dose progression; So far, the patient remains asymptomatic and normotensive.

Conclusions: Our patient suffered hypertensive episodes in the context of an adjustment disorder associated with testosterone treatment. Withdrawing testosterone resolved both the adjustment disorder and the hypertensive episodes. We consider that the increased blood pressure was not a direct consequence of testosterone, but an indirect result mediated by untoward psychological reactions of the patient.