Exogenous Hormone Therapy and Hyperprolactinemia: Evaluation and Management of Hyperprolactinemia

Hyperprolactinemia has been described as resulting from medically necessary exogenous hormone therapy (HT). However, as the knowledge of HT has evolved, when and why serum prolactin levels should be assessed in individuals with a transgender gender modality (TG) on HT has been questioned. Hyperprolactinemia is common and has a broad differential diagnosis. Hyperprolactinemia in TG individuals has been most associated with cyproterone acetate and estradiol, often not clinically significant. Routine monitoring should not be considered in TG individuals on HT unless clinically indicated when specific signs or symptoms of hyperprolactinemia (hypogonadism, galactorrhea) are present, and if present, HT discontinuation is unnecessary.