Treatment With a Nonaromatizable Androgen for Transgender Man With a Hormone-sensitive Ovarian Cancer

Gender-affirming hormone therapy (GAHT) is increasingly prescribed to transgender men and gender diverse individuals to better align their affirmed gender identity and somatic phenotype, aiming to improve psychosocial well-being. However, the long-term outcomes of GAHT, especially risk of hormone-related malignancy, remains unclear. We report a case of transgender man on long-term GAHT with testosterone who developed recurrent hormone-sensitive endometrioid ovarian cancer. Treatment with medroxyprogesterone acetate effectively suppressed serum estradiol (measured by liquid chromatography-mass spectrometry) but resulted in intolerable physical and mental health symptoms from hypogonadism. The nonaromatizable androgen 19-nortestosterone (nandrolone) was initiated as an alternative and successfully improved quality of life while maintaining bone and muscle health. This case underscores the importance of coordinated care within a multidisciplinary team.