SUN-138 Raloxifene use in gender diverse individuals

Abstract Disclosure: R. Sultan: None. Abstract:Transgender and gender-diverse (TGD) individuals often seek gender-affirming hormone therapy (GAHT) to align their physical traits with their gender identity. Non-binary individuals, in particular, may pursue hormone therapies that enhance specific features while avoiding others, such as feminizing traits without inducing breast development. Selective estrogen receptor modulators (SERMs), like raloxifene, have been explored for their ability to inhibit breast tissue development. However, the use of raloxifene in non-binary or agender individuals assigned male at birth (AMAB) is under-researched. This report presents three cases of non-binary/agender individuals using raloxifene (60 mg daily) to achieve more androgynous features without breast growth as part of their hormone therapy regimens.Case 1: Patient A (35, AMAB, they/them, agender/asexual)Initially, Patient A was prescribed low-dose oral estradiol and spironolactone but experienced distress due to breast sensitivity. After researching raloxifene, they initiated treatment following a discussion of potential risks. However, after 12 months, the patient opted to discontinue raloxifene due to a lack of notable feminizing changes and resumed estradiol while continuing spironolactone. A year later, they underwent a mastectomy. Post-raloxifene DXA showed a low lumbar spine Z-score of -3.1.Case 2: Patient B (22, AMAB, they/them, nonbinary)Patient B began low-dose estradiol and spironolactone, requesting raloxifene after three months. After four months with no feminizing effects, they stopped the medication. Resuming estradiol (2 mg daily) and spironolactone (50 mg twice daily) led to breast growth, which was less distressing. They are currently satisfied with the current results on stable doses of estradiol and spironolactone.Case 3: Patient C (29, AMAB, they/them, gender fluid)Patient C began raloxifene two years ago, achieving satisfaction with subjective improvements in skin texture and fat redistribution. They are content with their current treatment and wish to continue. Raloxifene is FDA-approved for osteoporosis in postmenopausal cisgender women, but its effects in AMAB individuals remain poorly understood. Although some body composition changes and improved skin elasticity have been observed, potential risks include increased thrombogenic risk, diabetes, and potentially lower bone mineral density. These cases highlight the need for further research to better understand the safety and efficacy of raloxifene in non-binary individuals. Clinicians must prioritize informed decision-making and closely monitor patients for potential health risks when considering raloxifene as part of GAHT. Further investigation into its long-term effects and safety profile is essential for optimizing care in this population. Presentation: Sunday, July 13, 2025