Endocrine Abstracts

Introduction

Anorexia nervosa is a severe and potentially lethal eating disorder. We report hereby the cases of two female-to-male transsexual patients whose anorexia nervosa was promptly resolved when they started gender-affirming hormone therapy.

Methods

Review of the patients’ clinical records and of the relevant literature.

Case reports

A 15 year-old male transexual with Asperger syndrome and intense gender dysphoria did not start the recommended LHRH agonist treatment at the Tanner II puberty stage by age 11 because parental consent was not obtained. He developed a severe eating disorder diagnosed as anorexia nervosa which required interment in a specialized unit and forced nutrition. By his 14 birthday he weighed 34 kg with a height of 162 cm (BMI <13 kg/m²). He had Tanner III axilarche and pubarche, Tanner II thelarche, and no menarche. At the age of 14 year 6 months parental consent for gender-affirming therapy was obtained and the patient began treatment with LHRH agonist and progressive transdermal testosterone treatment up to 60 mg/day. One year later his eating habits were normal, his BMI was 19.85 kg/m² (Height 177 cm, weight 62.2 kg), his FSH, LH and testosterone were in the normal male range and had no nutritional deficit except for low vitamin D. A 20 year-old male transsexual was interned due to extremely severe anorexia nervosa, with BMI < 11 kg/m², and inability to walk. He reported that he had gender dysphoria since childhood but had never expressed it. He had undergone female pubertal development with normal menses until the onset of anorexia nervosa, and had intense dysphoria centered in his breast development. When gender-affirming hormonal therapy and mastectomy were offered, he accepted nasogastric feeding and was discharged with parenteral testosterone treatment. 14 months later his eating habits are normal, his BMI is 20.4 kg/m², his FSH, LH and testosterone are in the normal male range and he has no nutritional deficit, but his mastectomy is still pending due to the COVID-19 pandemic.

Conclusion

In transsexual patients with severe gender dysphoria, a severe eating disorder (proposed name: dysphorexia), coherent with anorexia nervosa may be triggered by the desire to avoid the cisgender puberal transition. In these patients, gender-affirming hormone therapy can be extremely effective. We postulate that avoiding the cisgender puberal development with LHRH agonist treatment might be able to prevent the development of anorexia.