{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T11:25:07Z","timestamp":1789039507756,"version":"build-2803163510"},"reference-count":49,"publisher":"The Endocrine Society","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,11,1]]},"abstract":"Abstract<\/jats:title>\n \n Context<\/jats:title>\n Medroxyprogesterone acetate (MPA) is a widely used progestin in feminizing hormone therapy. However, the side effects and hormonal changes elicited by this drug have never been investigated in the transgender population.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n We evaluated the incidence of self-reported effects among transwomen using MPA and this drug\u2019s impact on hormonal and metabolic parameters.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n We retrospectively collected data from 290 follow-up visits (FUVs) of transwomen treated at Rhode Island Hospital from January 2011 to July 2018 (mean duration of therapy 3.4 \u00b1 1.7 years). FUVs followed regimens of estradiol (E) and spironolactone, with MPA (n = 102) or without MPA (n = 188).<\/jats:p>\n <\/jats:sec>\n \n Main Outcome Measures<\/jats:title>\n We assessed the incidence of self-reported effects after MPA treatment. We also compared blood levels of E, testosterone, and various laboratory parameters between MPA and non-MPA groups.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Mean weighted E level was 211 \u00b1 57 pg\/mL after MPA treatment and 210 \u00b1 31 pg\/mL otherwise; this difference was nonsignificant [t(274) = 0.143, P = 0.886]. Mean weighted testosterone level was 79 \u00b1 18 ng\/dL after MPA treatment and 215 \u00b1 29 ng\/dL otherwise; testosterone levels were significantly lower in the MPA group [t(122) = 32.4, P < 0.001]. There were minimal changes in other laboratory parameters. Of 39 patients receiving MPA, 26 reported improved breast development and 11 reported decreased facial hair. Five patients experienced mood swings on MPA.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n In our cohort of transwomen, we found minimal side effects, unchanged E levels, and a decline in testosterone associated with MPA, outcomes consistent with feminization. Prospective studies are needed to confirm our findings.<\/jats:p>\n <\/jats:sec>","DOI":"10.1210\/jc.2018-02253","type":"journal-article","created":{"date-parts":[[2019,4,25]],"date-time":"2019-04-25T09:03:39Z","timestamp":1556183019000},"page":"5148-5156","source":"Crossref","is-referenced-by-count":31,"title":["Medroxyprogesterone Acetate in Gender-Affirming Therapy for Transwomen: Results From a Retrospective Study"],"prefix":"10.1210","volume":"104","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9478-5018","authenticated-orcid":false,"given":"Jaison","family":"Jain","sequence":"first","affiliation":[{"name":"Gender and Sexual Health Services, Department of Pediatrics, Rhode Island Hospital, Providence, Rhode Island"},{"name":"Department of Plastic and Reconstructive Surgery, Rhode Island Hospital, Providence, Rhode Island"},{"name":"Warren Alpert Medical School of Brown University, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Kwan","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Rhode Island Hospital, Providence, Rhode Island"},{"name":"Warren Alpert Medical School of Brown University, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Forcier","sequence":"additional","affiliation":[{"name":"Gender and Sexual Health Services, Department of Pediatrics, Rhode Island Hospital, Providence, Rhode Island"},{"name":"Warren Alpert Medical School of Brown University, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","published-online":{"date-parts":[[2019,4,25]]},"reference":[{"issue":"2","key":"2019092505514170200_bib1","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1080\/15532739.2010.509215","article-title":"Recommendations for revision of the DSM diagnoses of gender identity disorders: consensus statement of the World Professional Association for Transgender Health","volume":"12","author":"Knudson","year":"2010","journal-title":"Int J Transgend"},{"issue":"11","key":"2019092505514170200_bib2","doi-asserted-by":"crossref","first-page":"3869","DOI":"10.1210\/jc.2017-01658","article-title":"Endocrine treatment of gender-dysphoric\/gender-incongruent persons: an Endocrine Society clinical practice guideline","volume":"102","author":"Hembree","year":"2017","journal-title":"J Clin Endocrinol Metab"},{"issue":"12","key":"2019092505514170200_bib3","first-page":"1953","article-title":"The effect of cross-sex hormonal treatment on gender dysphoria individuals\u2019 mental health: a systematic review","volume":"12","author":"Costa","year":"2016","journal-title":"Neuropsychiatr Dis Treat"},{"issue":"4","key":"2019092505514170200_bib4","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1016\/j.jsxm.2016.02.001","article-title":"Prevalence of transgender depends on the \u201ccase\u201d definition: a systematic review","volume":"13","author":"Collin","year":"2016","journal-title":"J Sex Med"},{"key":"2019092505514170200_bib5","unstructured":"Center of Excellence for Transgender Health, Department of Family and Community Medicine, University of California, San Francisco. Deutsch MB, ed. Guidelines for the primary and gender-affirming care of transgender and gender nonbinary people. 2nd ed. San Francisco, CA: University of California; 2016. Available at: www.transhealth.ucsf.edu\/guidelines. Accessed 1 August 2018."},{"issue":"4","key":"2019092505514170200_bib6","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1080\/15532739.2011.700873","article-title":"Standards of care for the health of transsexual, transgender, and gender non-conforming people, version 7","volume":"13","author":"Coleman","year":"2012","journal-title":"Int J Transgend"},{"issue":"3","key":"2019092505514170200_bib7","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1001\/jama.288.3.321","article-title":"Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women\u2019s Health Initiative randomized controlled trial","volume":"288","author":"Rossouw","year":"2002","journal-title":"JAMA"},{"issue":"4","key":"2019092505514170200_bib8","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1089\/15246090050020691","article-title":"Comparison of regimens containing oral micronized progesterone or medroxyprogesterone acetate on quality of life in postmenopausal women: a cross-sectional survey","volume":"9","author":"Fitzpatrick","year":"2000","journal-title":"J Womens Health Gend Based Med"},{"key":"2019092505514170200_bib9","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.jsbmb.2013.11.011","article-title":"Use of medroxyprogesterone acetate for hormone therapy in postmenopausal women: is it safe","volume":"142","author":"Stanczyk","year":"2014","journal-title":"J Steroid Biochem Mol Biol"},{"issue":"2","key":"2019092505514170200_bib10","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/S0010-7824(03)00136-7","article-title":"Depot-medroxyprogesterone acetate injection (Depo-Provera): a highly effective contraceptive option with proven long-term safety","volume":"68","author":"Westhoff","year":"2003","journal-title":"Contraception"},{"issue":"7","key":"2019092505514170200_bib11","doi-asserted-by":"crossref","first-page":"1708","DOI":"10.1093\/humrep\/der138","article-title":"Spermatogenetic inhibition in men taking a combination of oral medroxyprogesterone acetate and percutaneous testosterone as a male contraceptive method","volume":"26","author":"Soufir","year":"2011","journal-title":"Hum Reprod"},{"issue":"1","key":"2019092505514170200_bib12","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/S0015-0282(16)48326-3","article-title":"Physical, metabolic, and hormonal effects on men of long-term therapy with medroxyprogesterone acetate","volume":"43","author":"Meyer","year":"1985","journal-title":"Fertil Steril"},{"key":"2019092505514170200_bib13","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1176\/appi.books.9780890425596","volume-title":"Diagnostic and Statistical Manual of Mental Disorders","author":"American Psychiatric Association","year":"2013","edition":"5th ed."},{"key":"2019092505514170200_bib14","unstructured":"Jain\n J\n , KwanD, ForcierM. Data from: Medroxyprogesterone acetate in gender-affirming therapy for transwomen: results from a retrospective study. figshare 2018. 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