ArticleThe Journal of clinical endocrinology and metabolism2021
Toward a Lowest Effective Dose of Cyproterone Acetate in Trans Women: Results From the ENIGI Study.
Article in The Journal of clinical endocrinology and metabolism, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
30 citing papers in PubMed, 1 synthesis or guideline pooled it, 60 citations in OpenAlex.
- Systematic review of PSA reference intervals in the gender diverse population with prostates.BJU international · 2025Pooled it
- Effect of Spironolactone and Cyproterone Acetate on Breast Growth in Transgender People: A Randomized Clinical Trial.The Journal of clinical endocrinology and metabolism · 2025Trial
- Impact of Distinct Antiandrogen Exposures on the Plasma Metabolome in Feminizing Gender-affirming Hormone Therapy.The Journal of clinical endocrinology and metabolism · 2024Trial
- Therapeutic Issues Associated with Gender-Affirming Hormone Therapy in Transgender Individuals: A Systematic Review Relevant to Community Pharmacy Practice.Pharmacy (Basel, Switzerland) · 2026Review
- Progestins - a review of clinical application in gynecology.Annals of medicine · 2025Review
- Prolactinoma Resection in a Transgender Woman on Gender-affirming Hormone Therapy.JCEM case reports · 2025Article
- Flow chemistry-enabled asymmetric synthesis of cyproterone acetate in a chemo-biocatalytic approach.Nature communications · 2025Article
- Article
- Approach to prolactin monitoring and hyperprolactinaemia in transgender and gender-diverse individuals undergoing gender affirming hormone therapy.Frontiers in endocrinology · 2025Article
- Hemostatic parameters in transgender women receiving gender-affirming hormone therapy: A shift to a cisgender female pattern?PloS one · 2025Article
- Factors influencing overdose and misuse of gender-affirming medication in Chinese transgender and gender diverse individuals: A qualitative study of experience and perspectives.International journal of transgender health · 2025Article
- How low can you go? Titrating the lowest effective dose of cyproterone acetate for transgender and gender diverse people who request feminizing hormones.International journal of transgender health · 2025Article
- High-Dose Cyproterone Acetate and Intracranial Meningioma: Impact of the Risk Minimisation Measures Implemented in France in 2018-2019.Pharmacoepidemiology and drug safety · 2025Article
- Assessment of parenteral estradiol and dihydroxyprogesterone use among other feminizing regimens for transgender women: insights on satisfaction with breast development from community-based healthcare services.Annals of medicine · 2024Article
- Giant Intracranial Meningiomas Requiring Surgery in 2 Transgender Women Treated With Cyproterone Acetate.JCEM case reports · 2024Article
- Effectiveness of low dose cyproterone acetate compared to standard dose in feminizing hormone treatment: a single institutional retrospective pilot study.Sexual medicine · 2024Article
- Approach to the Patient: Hormonal Therapy in Transgender Adults With Complex Medical Histories.The Journal of clinical endocrinology and metabolism · 2024Article
- Risk assessment of transgender people: implementation of a demasculinizing-feminizing rodent model including the evaluation of thyroid homeostasis.Biology direct · 2024Article
- Effect of bicalutamide on serum total testosterone concentration in transgender adults: a case series.Therapeutic advances in endocrinology and metabolism · 2024Article
- The efficacy of and user satisfaction with different antiandrogens in Chinese transgender women.International journal of transgender health · 2024Article
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Authors and funding
6 authors at 3 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
contextCyproterone acetate (CPA) is a competitive inhibitor of the androgen receptor and exerts negative hypothalamic feedback. It is often used in combination with estrogens in trans women to achieve feminization. However, CPA has been associated with side effects such as changes in liver enzyme concentrations and increases in prolactin concentrations. The question is whether the testosterone-lowering effect, as well as these side effects, are dose dependent.
objectiveTo assess the lowest effective dose of CPA in trans women to prevent side effects.
methodsThis longitudinal study, conducted at gender identity centers in Amsterdam, Ghent, and Florence, is part of the European Network for the Investigation of Gender Incongruence (ENIGI), a multicenter prospective cohort study. Participants were trans women (n = 882) using estrogens only or in combination with 10, 25, 50, or 100 mg CPA daily. The primary outcome measure was the concentration of testosterone at 3 and/or 12 months of hormone therapy.
resultsUsing estrogens only (without CPA) led to testosterone concentrations of 5.5 nmol/L (standard error of the mean [SEM] 0.3). All doses of CPA resulted in testosterone concentrations below the predefined threshold of suppression of 2 nmol/L (10 mg, 0.9 nmol/L, SEM 0.7; 25 mg, 0.9 nmol/L, SEM 0.1; 50mg, 1.1 nmol/L, SEM 0.1; 100 mg, 0.9 nmol/L, SEM 0.7). Higher prolactin and lower high-density lipoprotein concentrations were observed with increasing doses of CPA. No differences in liver enzyme concentrations were found between the doses.
conclusionCompared with higher doses of CPA, a daily dose of 10 mg is equally effective in lowering testosterone concentrations in trans women, while showing fewer side effects.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.