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Epilepsy Management in Transgender and Gender Diverse People

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Abstract

Purpose of review

The goal of this review is to outline important topics in epilepsy management for transgender and gender diverse individuals. Specifically, we describe the common gender-affirming hormone treatment regimens, how these changes in estrogens and androgens may affect seizure threshold and anti-seizure medications, and how anti-seizure medications may in turn impact hormone levels.

Recent findings

Although data are mixed, most studies point to proconvulsant properties of estrogen and anticonvulsant properties of progesterone and testosterone, raising the possibility of an increased risk of breakthrough seizures when starting on feminizing gender-affirming hormone treatment. Feminizing hormone regimens containing estrogen are likely to significantly decrease serum concentration of lamotrigine. Enzyme-inducing anti-seizure medications decrease circulating levels of estrogens and androgens, which may potentially decrease the efficacy of gender-affirming hormone treatments.

Summary

While a general approach to the care of transgender individuals with epilepsy may be extrapolated from existing studies on hormonal interactions in cisgender individuals, there is a clear need for further research more closely examining the complex interactions between epilepsy, anti-seizure medications, and gender-affirming hormone therapy in transgender and gender diverse individuals.

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Authors and Affiliations

  1. Division of Epilepsy, Department of Neurology, University of Pennsylvania, 3400 Spruce Street, 3 West Gates Building, Philadelphia, PA, 19104, USA

    Catherine V. Kulick-Soper MD & Genna Waldman MD

Authors
  1. Catherine V. Kulick-Soper MD
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  2. Genna Waldman MD
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Contributions

C.K. and G.W. wrote main manuscript text and reviewed manuscript. G.W. prepared Table 1.

Corresponding author

Correspondence to Genna Waldman MD.

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Catherine V. Kulick-Soper declares that she has no conflict of interest. Genna Waldman declares that she has no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Kulick-Soper, C.V., Waldman, G. Epilepsy Management in Transgender and Gender Diverse People. Curr Treat Options Neurol 25, 419–427 (2023). https://doi.org/10.1007/s11940-023-00771-6

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  • DOI: https://doi.org/10.1007/s11940-023-00771-6

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