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The AAPS 103rd Annual Meeting 2025
May 24-27, 2025 | Austin, Texas
D86
The Impact of Gender-Affirming Hormone Therapy on Seizure Occurrence in Transgender and Gender-Diverse Individuals
Poster Presenter
Authors
Camille Blackman, BA, Diane Saab, MPH, Danielle Mayorga-Young, BS, Danielle Sim, BS, Fan Liang, MD, Bashar Hassan, MD, MPH, Emily Johnson, MD, MPH
Affiliations
Center for Transgender and Gender Expansive Health, Johns Hopkins Hospital, Department of Plastic and Reconstructive Surgery, Department of Neurology, Johns Hopkins University School of Medicine
Part of Topic
Gender Affirmation
Background
•Epilepsy disproportionately affects transgender and gender-diverse (TGD) individuals.
•Effect of feminizing (FHT) and masculinizing (MHT) gender-affirming hormone therapy (GAHT) on seizure activity is poorly understood.
- Estrogen may lower the seizure threshold.
- Testosterone may have anticonvulsant effects.
•GAHT interaction with anti-seizure meds (ASMs) complicates treatment.
Research Question: How does GAHT influence seizure occurrence in TGD individuals with seizure history or confirmed epilepsy?
Methods
•Retrospective cohort study of TGD individuals (2002–2024) with seizures and on GAHT.
- Included: confirmed seizures, documented GAHT, adequate follow-up.
- Excluded: poor ASM adherence, simultaneous FHT+MHT, provoked or functional seizures only.
•Primary outcome: Seizure occurrence before vs. after GAHT (McNemar’s test).
•Secondary outcome: Seizure occurrence after FHT vs. MHT (Chi-square).
Results
•34 patients included: n=13 on FHT; n=21 on MHT
•Seizures before GAHT: 82.4% | after GAHT: 47.1%
•Among the 28 patients with seizures before GAHT:
– 18 (53.0%) no longer had seizures after GAHT
– 10 (29.4%) continued to have seizures
– 6 (17.6%) patients developed seizures after GAHT
– Reduction in seizure occurrence was statistically significant (p=0.025)
– 18 (53.0%) no longer had seizures after GAHT
– 10 (29.4%) continued to have seizures
– 6 (17.6%) patients developed seizures after GAHT
– Reduction in seizure occurrence was statistically significant (p=0.025)
•No significant difference in post-GAHT seizure occurrence between FHT (30%) and MHT (38.9%) (p=0.7)
•Among 15 patients with confirmed epilepsy: No significant difference in post-GAHT seizure occurrence between FHT (50%) and MHT (54.5%) (p=1.0)
•MHT associated with a trend toward reduced seizures (p=0.06); FHT: no significant change (p=0.34)
•Patients with stable anti-seizure medication regimens had improved seizure control (p=0.015)
Conclusions
•GAHT was not associated with increased seizure occurrence.
•FHT and MHT were not linked to new seizure risk in patients with known epilepsy.
•Small sample size limits definitive conclusions, but initial findings support individualized perioperative planning for plastic surgeons treating TGD individuals on GAHT with epilepsy.