12330 Progestogen Experience And Perception Among Transfeminine Adults - A National Survey
Authors: Chang Julia J , Tran Nguyen Khai , Flentje Annesa , Lubensky Micah E , Obedin-Maliver Juno , Lunn Mitchell R , Ariel Danit 
Published: October 2024

Abstract
Disclosure: J.J. Chang: None. N. Khai Tran: None. A. Flentje: None. M.E. Lubensky: None. J. Obedin-Maliver: Consulting Fee; Self; Ibis Reproductive Health, Hims, Incorporated, Folx, Incorporated, Upstream, Incorporated. M.R. Lunn: Consulting Fee; Self; Hims, Incorporated, Otsuka Pharmaceutical Development and Commercialization, Inc., American Dental Association. D. Ariel: None.
Background: Current guidelines recommend estradiol with consideration of anti-androgens for gender-affirming hormone therapy (GAHT) in transfeminine adults. Many individuals also seek progestogens as part of feminizing GAHT, particularly to enhance breast development. Though progestogen use seems common, few studies describe its use, reported benefits, and side effects. SpecificAims: 1) To describe progestogen use in feminizing GAHT among transfeminine individuals in the U.S. 2) To evaluate reasons for progestogen initiation and perceived physical and emotional impact; 3) To investigate side effects and adverse events. Materials and Methods: In this cross-sectional study, participants were recruited from The PRIDE Study, a U.S.-based longitudinal cohort study of LGBTQIA+-identifying adults. Included participants were assigned male sex at birth and had a feminine/transfeminine or non-binary gender identity. Those assigned female sex at birth (AFAB) or born with 1 or more ovaries were excluded. Descriptive statistics were used to describe socio-demographic characteristics, progestogen use patterns, initiation reasons, perceived physical and mental impacts, side effects, adverse events, and care satisfaction. Results: 543 participants were eligible and completed the study. Mean age was 43.2 years (standard deviation: 14.9). Of 310 progestogen users, the most common progestogen forms were micronized progesterone (58.4% oral; 10.6% rectal) and medroxyprogesterone acetate (7.7% oral). Median progestogen use duration was 2 years (interquartile range: 1-4). Breast development (85.2%) and mimicking the hormone pattern of those AFAB (58.1%) were the two most reported reasons for progestogen initiation. Most progestogen users reported improved breast development (79.7%); none reported worsening. Sex drive, sleep, and concentration did not change with progestogen use in 46.5%, 51.3%, and 73.9% of participants, respectively. Adverse events included lower extremity deep vein thrombosis (n = 6) and pulmonary embolism (n = 4). The most common side effects were breast pain (28.7%), mood fluctuation (21.9%), fatigue (19.7%), and weight gain (19.0%). Most users expressed satisfaction with progestogens (71.9%) and would recommend to others (73.5%). Among 68 former progestogen users, 20.6% reported stopping progestogens due to negative side effects, and 32.4% stopped due to lack of perceived efficacy. Conclusions: In the largest study describing progestogens in GAHT to date, over half of transfeminine adults used progestogens, particularly for breast development. Most reported improvement with breast development and overall satisfaction. However, perceived impacts on other effects were variable. Future prospective studies are needed to investigate the effects of progestogens versus other components of feminizing GAHT.
Presentation: 6/1/2024