Caring for transgender patients with epilepsy

Epilepsia. 2017 Oct;58(10):1667-1672. doi: 10.1111/epi.13864. Epub 2017 Aug 3.


Objective: Approximately 25 million individuals older than age 15 identify as transgender, representing about 0.3-0.9% of the world's population. The aim of this paper is to identify and describe important medical and social considerations facing transgender persons with epilepsy.

Methods: We performed literature searches on the following terms: transgender AND epilepsy, transgender AND neurology, gender dysphoria AND epilepsy, gender dysphoria AND neurology. We also performed literature searches for common feminizing or masculinizing treatment regimens, and searched for interactions of those treatment regimens with antiepileptic drugs (AEDs) and with seizures.

Results: There are multiple bidirectional interactions between AEDs and the commonly used treatments for aligning external sex characteristics with identified gender. The scope of the transgender population with epilepsy remains to be elucidated.

Significance: Transgender patients with epilepsy face significant social and medical challenges. Interactions between medical gender-affirming treatments and AEDs are common, and management must depend on knowledge of these interactions to provide appropriate treatment.

Keywords: Antiepileptic drugs; Female-to-male; Gender identity; Male-to-female; Seizures.

Publication types

  • Review

MeSH terms

  • Androgens / therapeutic use*
  • Anti-HIV Agents / therapeutic use
  • Anticonvulsants / therapeutic use*
  • Antidepressive Agents / therapeutic use
  • Anxiety Disorders / epidemiology
  • Comorbidity
  • Depressive Disorder / drug therapy
  • Depressive Disorder / epidemiology
  • Drug Interactions
  • Epilepsy / drug therapy*
  • Epilepsy / epidemiology
  • Epilepsy / physiopathology
  • Estradiol / therapeutic use
  • Estrogens / therapeutic use*
  • HIV Infections / drug therapy
  • HIV Infections / epidemiology
  • Health Services for Transgender Persons
  • Humans
  • Medroxyprogesterone / therapeutic use
  • Mineralocorticoid Receptor Antagonists / therapeutic use*
  • Progestins / therapeutic use*
  • Social Stigma
  • Spironolactone / therapeutic use
  • Testosterone / therapeutic use
  • Transgender Persons
  • Transsexualism / drug therapy*
  • Transsexualism / epidemiology


  • Androgens
  • Anti-HIV Agents
  • Anticonvulsants
  • Antidepressive Agents
  • Estrogens
  • Mineralocorticoid Receptor Antagonists
  • Progestins
  • Spironolactone
  • Testosterone
  • Estradiol
  • Medroxyprogesterone