Low-Dose Cyproterone Acetate Treatment for Transgender Women

J Sex Med. 2021 Jul;18(7):1292-1298. doi: 10.1016/j.jsxm.2021.04.008. Epub 2021 Jun 24.


Background: Transgender women with intact gonads receive lifelong hormonal treatment to suppress physiologic androgen production, the optimal efficacious and safe cyproterone acetate (CPA) dose has not been established.

Aim: To assess the effectiveness and safety of low-dose (10-20 mg/day) compared with high-dose (50-100 mg/day) CPA treatment.

Methods: We conducted a historical cohort study of transgender women treated at a tertiary center for transgender health.

Outcome measures: Serum levels of testosterone, estradiol, prolactin, gonadotrophins, liver enzymes, and lipids.

Results: There were 38 transgender women in the low-dose group and 26 in the high-dose group. Age (median 24.9 years, interquartile range [IQR] 21-30 vs 25 years, IQR 19-35) and follow-up time (median 12 months, IQR 6-23 vs 15 months, IQR 12-36) were similar in the low- and high-dose groups, respectively. Serum gonadotropins and testosterone were suppressed to a similar level at all time points in both groups. Prolactin levels increased significantly in both groups, however, with a more substantial increase in the high- vs the low-dose group (804 ± 121 vs 398 ± 69 mIU/ml at 12 months, respectively, P = .004). Total cholesterol, high-density lipoprotein, low-density lipoprotein, and triglyceride levels were not significantly affected by the dose.

Clinical implications: We suggest an adjustment of current clinical practice guidelines to recommend lower doses of CPA for the treatment of transgender women.

Strengths & limitations: This is the first demonstration that low-dose CPA treatment of transgender women is effective. Limitations include a relatively small sample and retrospective study design.

Conclusion: Low-dose CPA treatment of transgender women is as effective as high-dose treatment and possibly safer. Zohar NE, Sofer Y, Yaish I, et al. Low-Dose Cyproterone Acetate Treatment for Transgender Women. J Sex Med 2021;18:1292-1298.

Keywords: Anti-Androgen; Cyproterone Acetate; Testosterone; Transgender.

MeSH terms

  • Androgen Antagonists / therapeutic use
  • Child, Preschool
  • Cohort Studies
  • Cyproterone
  • Cyproterone Acetate / therapeutic use
  • Female
  • Humans
  • Infant
  • Retrospective Studies
  • Testosterone
  • Transgender Persons*
  • Transsexualism* / drug therapy


  • Androgen Antagonists
  • Testosterone
  • Cyproterone Acetate
  • Cyproterone