No label defined (Q32697)

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  • Management of breakthrough bleeding in transgender and gender diverse individuals on testosterone.
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English
No label defined
No description defined
  • Management of breakthrough bleeding in transgender and gender diverse individuals on testosterone.

Statements

Management of breakthrough bleeding in transgender and gender diverse individuals on testosterone. (English)
1 reference
While many transgender and gender diverse individuals rapidly achieve amenorrhea on testosterone, emerging data have identified that breakthrough bleeding can occur in up to one-third of individuals with long-term use. (English)
BACKGROUND (English)
Copyright © 2024 Elsevier Inc. All rights reserved. (English)
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Breakthrough bleeding can worsen dysphoria and patients may seek management to reattain amenorrhea. (English)
BACKGROUND (English)
Copyright © 2024 Elsevier Inc. All rights reserved. (English)
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Because of this, there is a need to assess efficacy of management approaches. (English)
BACKGROUND (English)
Copyright © 2024 Elsevier Inc. All rights reserved. (English)
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The primary aim of the study was to evaluate methods used by patients and their providers to manage breakthrough bleeding which arises after 1 year of testosterone use. (English)
OBJECTIVE (English)
Copyright © 2024 Elsevier Inc. All rights reserved. (English)
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Secondary aims included describing the diagnostic approaches to breakthrough bleeding, and proposing an algorithm for classification and management of breakthrough bleeding in this patient population. (English)
OBJECTIVE (English)
Copyright © 2024 Elsevier Inc. All rights reserved. (English)
1 reference
This was an institutional review board-approved single tertiary center, retrospective chart review of transgender and gender diverse individuals on testosterone gender affirming hormone therapy who experienced breakthrough bleeding after 1 year of use. (English)
STUDY DESIGN (English)
Copyright © 2024 Elsevier Inc. All rights reserved. (English)
1 reference
Charts were reviewed to determine patient characteristics, testosterone use, and breakthrough bleeding management approaches. (English)
STUDY DESIGN (English)
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1 reference
Of the 96 individuals who had been on testosterone for 1 year and experienced breakthrough bleeding, 97% (n=93) engaged in at least 1 approach to management. (English)
RESULTS (English)
Copyright © 2024 Elsevier Inc. All rights reserved. (English)
1 reference
The mean age at initiation of testosterone was 21.9 (standard deviation 5.4) and the median duration of time on testosterone was 54.5 months (interquartile range 33.5, 82). (English)
RESULTS (English)
Copyright © 2024 Elsevier Inc. All rights reserved. (English)
1 reference
Only 16% (n=15) were using menstrual suppression at the time of their breakthrough bleeding episode. (English)
RESULTS (English)
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Breakthrough bleeding was successfully managed in 77 (79%), following between 1 and 4 attempted approaches. (English)
RESULTS (English)
Copyright © 2024 Elsevier Inc. All rights reserved. (English)
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More than half of management attempts (63%) were successful on the first try. (English)
RESULTS (English)
Copyright © 2024 Elsevier Inc. All rights reserved. (English)
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When management approaches were analyzed independently, the range of success associated with any particular approach was between 33% and 100%. (English)
RESULTS (English)
Copyright © 2024 Elsevier Inc. All rights reserved. (English)
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Other than hysterectomy, which was fully successful at managing breakthrough bleeding, no approach was significantly better than no intervention. (English)
RESULTS (English)
Copyright © 2024 Elsevier Inc. All rights reserved. (English)
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This was true both for individuals who did and did not bleed with missed testosterone doses. (English)
RESULTS (English)
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1 reference
Regardless of what approach was used, after a failed attempt, the next attempt was successful in more than half of individuals. (English)
RESULTS (English)
Copyright © 2024 Elsevier Inc. All rights reserved. (English)
1 reference
Of the 16 who underwent hysterectomy, 1 did so in part as a first line approach to manage breakthrough bleeding. (English)
RESULTS (English)
Copyright © 2024 Elsevier Inc. All rights reserved. (English)
1 reference
In this study, use of medical management methods was not found to be superior to observation alone in the management of breakthrough bleeding. (English)
CONCLUSION (English)
Copyright © 2024 Elsevier Inc. All rights reserved. (English)
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In the absence of data supporting superiority of any method, we recommend tailoring method attempts to patients' goals. (English)
CONCLUSION (English)
Copyright © 2024 Elsevier Inc. All rights reserved. (English)
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November 2024
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November 2024
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231
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5
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534.e1-534.e11
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534.e1
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534.e11
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S0002-9378(24)00667-7
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