S5871 Hepatocellular Adenoma Associated With Testosterone-Based Gender-Affirming Hormone Therapy in a Transgender Man

Introduction: Transgender and gender-diverse (TGD) individuals may receive gender-affirming hormone therapy (GAHT), testosterone for transgender men and estradiol for transgender women, to align their physical appearance with gender identity. While GAHT is generally safe, rare associations between long-term testosterone use and hepatobiliary neoplasms, particularly hepatocellular adenoma in transgender men, have been reported. We describe a case of hepatocellular adenoma in a transgender man likely linked to prolonged testosterone therapy. Case Description/Methods: A 19-year-old transgender man on transdermal testosterone and norethindrone for 4 years presented with chronic abdominal cramping. His medical history included dyslipidemia (treated with atorvastatin) and new persistent liver enzyme elevations over the preceding 6 months. He denied alcohol and tobacco use; family history was unremarkable. Physical examination revealed a body mass index of 33 kg/m² with otherwise unremarkable exam. Laboratory studies showed elevated alanine aminotransferase (121 U/L), aspartate aminotransferase (44 U/L), and alkaline phosphatase (148 U/L); normal bilirubin (0.4 mg/dL), albumin (4.7 g/dL), platelets (363 × 10³/µL), PT/international normalized ratio, and CRP; and a positive ANA (1:160) with negative anti–smooth muscle antibody and negative viral hepatitis serologies. An abdominal ultrasound performed 18 months prior had shown increased hepatic echogenicity without focal lesions. Current MRI identified 3 liver masses, the largest measuring 6 cm in segment 8. Percutaneous biopsy confirmed hepatocellular adenoma. Testosterone therapy was held, and plans were made for close follow-up with interval imaging. Discussion: Hepatocellular adenomas in transgender men on testosterone-based GAHT are rare, with fewer than 5 cases reported to date, and progestins appear to play a negligible role in this context. Because uninterrupted access to GAHT is vital for many TGD individuals, a multidisciplinary approach is critical to enable prompt identification and management of hepatic lesions while minimizing interruptions to GAHT. Clinicians should remain vigilant for potential liver complications in TGD patients receiving testosterone, ensuring that hormone therapy can continue safely whenever feasible. Larger cohort studies and dedicated registries are needed to determine the true incidence and risk factors for hepatobiliary neoplasms in this population.