Endocrine Abstracts

A 38-year-old transsexual woman, with no known drug allergies, active tobacco smoker, ICAT 2. As diseases of interest, stage A2 human immunodeficiency virus (HIV) infection with current negative viral load. Lúes in 2012 treated. In treatment with Stribild (elvitegravir 150 mg/ cobicistat 150 mg/ emtricitabine 200 mg/ tenofovir disoproxil fumarate 245 mg). She went to the Transsexual Persons Care Unit due to gender inconsistency since childhood with the adoption of the female role for years. She now expresses her desire to start hormonal and surgical treatment to try to accommodate her secondary sexual characteristics to the desired sex. After the directed anamnesis and carrying out of complementary tests according to the recommendations of the Assistance Process of Attention to Transsexual People in Andalusia, cross-hormonal therapy is started. Antiandrogenic treatment was prescribed with cyproterone acetate 50 mg/day and estrogenic treatment with estradiol valerate at progressive doses up to a final dose of 6 mg/day (maximum recommended dose). However, despite adequate adherence to treatment and the high doses of estrogen used, plasma levels of estradiol remained low. Given the suspicion of possible interaction between antiretroviral treatment and estradiol valerate, Internal Medicine was consulted, deciding to change treatment to Triumeq (dolutegravir 50 mg/abacavir 600 mg/lamivudine 300 mg). Six months after the change in treatment, the target plasma estradiol levels were reached, even allowing the dose of estradiol valerate to be reduced to 4 mg/day. A prevalence of 19.1% of HIV-infected transsexual women is estimated. Several studies have associated the use of ritonavir-boosted protease inhibitors or cobicistat with a decrease in exogenous estrogen levels. The use of non-analog reverse transcriptase inhibitors (nevirapine, efavirenz) with decreased estrogen levels has also been described. Therefore, based on current evidence, the best option as antiretroviral treatment in transsexual women with cross-hormonal therapy could be a nucleoside reverse transcriptase inhibitor (such as abacavir, lamivudine) together with an integrase inhibitor (dolutegravir, raltegravir) without booster.