Table 1.

Studies of the effects of antiandrogens on prolactin levels, hyperprolactinemia, and prolactinomas in transgender women on estrogen therapy.

Author, year Study name Location	Study design	Start year	Length of followup	Transfeminine population	Type of antiandrogen	Route of administration for estrogen	Mean age (age range)	Mean BMI (BMI range)	Risk of bias
Defreyne et al., 2017 ENIGI Europe	Prospective cohort	2010	18 months	Hormone therapy naïve	Cyproterone acetate	Oral, transdermal patch, or transdermal gel	30.75	23.12	Serious
					Cyproterone acetate	Oral, transdermal patch, or transdermal gel +  orchiectomy	32.35	23.26
Nota et al., 2017* ENIGI Europe	Prospective cohort	2012	12 months	Hormone therapy naive	Cyproterone acetate	Oral or transdermal patch	34 (19 to 69)	NR	Serious
Wierckx et al., 2014 ENIGI Europe	Prospective cohort	2010	12 months	Hormone therapy naïve	Cyproterone acetate	Oral	19.3 to 31.7†	22.9 to 23.9†	Moderate
					Cyproterone acetate	Transdermal patch or transdermal gel	NR	NR
Giltay et al., 2005 Europe	Prospective cohort	1996	4 months	NR	Cyproterone acetate	Oral	32.4 (20 to 43)	22.8	Moderate
Manieri et al., 2014 Europe	Prospective cohort	NR	12 months	NR	Cyproterone acetate	Oral	32.7	NR	Serious
Asscheman et al., 1989 Europe	Retrospective cohort	1972	3.6 to 4.4 years	NR	Cyproterone acetate	Oral or IM	Median, 32 (16 to 67)	NR	Moderate
Cunha et al., 2018 South America	Retrospective cohort	NR	6 months	Hormone therapy naïve	Cyproterone acetate	Oral	38.3 (23 to 58)‡	NR	Serious
					None	Oral	NR	NR
Fung et al., 2016 North America	Retrospective cohort	2009	12 months	Hormone therapy naïve or newly starting hormone therapy	Cyproterone acetate	Oral or transdermal	38.2	25.5	Moderate
					Spironolactone	Oral or transdermal	32.9	25.0
Nota et al., 2017* Europe	Retrospective cohort	2009	2.2 years	Aged > 18 years, hormone therapy naïve	Cyproterone acetate	Oral or transdermal	37 (19 to 63)	NR	Serious
Tack et al., 2017 Europe	Retrospective cohort	2008	12 to 16 months	Tanner stage G4 or higher	Cyproterone acetate	NR	16.5	NR	Serious
van Kesteren et al., 1997 Europe	Retrospective cohort	1975	NR	Hormone therapy > 2 months	Cyproterone acetate	Oral or transdermal patch	41 (18 to 86)	NR	Moderate
Becerra Fernandez et al., 1999 Europe	Cross-sectional	1993	NA	Hormone therapy > 6 months	Cyproterone acetate	IM	29.9 (18 to 42)	NR	Serious
Olson-Kennedy et al., 2018 North America	Prospective cohort	2011	21 to 31 months	Aged 12 to 24 years, hormone therapy naïve or < 3 months of previous use	Spironolactone or GnRH analogue	NR	(12 to 23)	24.60	Moderate
Bisson et al., 2018 North America	Retrospective cohort	2015	6 years	NR	Spironolactone	Oral or transdermal	41 (20 to 68)	28 (19 to 44)	Serious
Jain et al., 2019 North America	Retrospective cohort	2011	3.4 years	Eugonadal	Spironolactone +  medroxyprogesterone acetate	Sublingual or transdermal	31 (14 to 69)‡	NR	Moderate
					Spironolactone	Sublingual or transdermal	NR	NR
Dittrich et al., 2005 Europe	Prospective cohort	NR	24 months	Hormone therapy naïve, eugonadal	Goserelin acetate (SC)	Oral	38.37	24.19	Serious
Hannema et al., 2017 Europe	Prospective cohort	1998	3 years	Treated with estrogen for > = 12 months	Triptorelin (IM)	Oral	Median, 16 (13.9 to 18.9)	20.8	Serious

BMI = body mass index; ENIGI = European Network for the Investigation of Gender Incongruence; GnRH = gonadotropin-releasing hormone; IM = intramuscular; NA = not applicable; NR = not reported; SC = subcutaneous.

*This publication included both a prospective study and a retrospective study.

†Range in mean values stratified by study center.

‡Mean age and age range for the total sample.