Feb 202017
 

“Brain tumor” are two words that strike fear into most hearts. They conjure images of thin patients with heads shaved and large fresh scars on their heads, of rapid neurological deterioration, and of sick children. Not all brain tumors are the same, however. Some are aggressive malignant cancer. Those are the bad actors like medullablastoma. They grow and spread quickly, and are very difficult to treat. Others are benign. These grow slowly, and either don’t spread or are very slow to spread. Benign brain tumors include meningioma, which we’re talking about today.

Meningioma is a tumor of the meninges, a thin layer that covers the brain. Meningiomas are benign. They don’t tend to metastasize (spread to other areas of the body). Instead, they grow and can grow enough that they squish parts of the brain. This causes headaches, loss of vision, and changes in thinking and mood.

Brain tumors are rare. So are meningiomas. They affect roughly 97/100,000 people. We don’t yet know exactly what causes them. But by looking are who tends to get them, we have some guesses. Exposure to radiation of the head seems to increase the risk. So does having a condition called Neurofibromatosis II. And meningiomas are more common in cisgender women than in cisgender men. Why? Because of hormones. Like breast cancer, meningioma can grow in response to estrogen or progesterone. Cis men who have been treated for prostate cancer (involving androgen deprivation therapy) are at higher risk. And perhaps trans women are too.

Today’s Paper

And that’s what brings us to today’s paper. We’ve covered meningiomas in trans women once before, but it’s time to take another look now that we have more data.

Today’s paper discusses three new cases of meningioma in trans women. In total now, 8 cases have been discussed in the medical literature. It’s a very small number, but enough to start seeing some patterns.

Of these three new cases, all were over the age of 45, were post-vaginoplasty, and were on cyproterone acetate along with an estrogen. All had surgery to remove the tumor, and they did well. The decision to continue hormone therapy was made on a case-by-case basis.

The authors noted a previous paper that found that cyproterone acetate was associated with meningioma. This was particularly true with doses above 25mg a day. Among the eight cases of meningioma in trans women in the literature, only one was not on cyproterone acetate. Doses ranged from 10mg to 100mg, with most being on 50mg or 100mg. The authors also found reports of higher rates of meningioma among people who use progesterone-like medications. Removing hormone therapy (especially cyproterone acetate) frequently helps to shrink the tumor.

What should you do with this information?

First, don’t panic about meningioma. It’s rare and benign.

There is no screening for meningioma. Instead, if you have any unusual symptoms like changes in your vision or headaches, talk with your doctor.

If you are a trans woman, consider taking the smallest dose of hormones possible. In general, high doses increase side effects and don’t help with transition. If you are diagnosed with a meningioma, have an honest conversation with your doctors about your hormone therapy.

And, of course, be sure to live as healthy a life as you can. Don’t go jumping into volcanos or nuclear power plants. Eat a balanced diet, get some exercise, avoid most drugs, and take care of yourself.

Want to read the article for yourself? The abstract is publicly available.

Jun 212013
 

Image © Kristy Peet. Used under creative commons license: CC BY 2.0A third case report of a meningioma in a trans woman has just been published.

A meningioma is a tumor of the meninges, the tissues between the skull and the brain. Most meningiomas come from the arachnoid mater, through which the cerebrospinal fluid sluggishly flows. Meningiomas are mostly (90%) benign, meaning they are not cancerous and will not spread throughout the body. Current treatment is surgery to remove the tumor, with radiation available if surgery is not possible.

There is some thought that sex hormones are a factor in the growth of meningiomas. Women are more likely to develop a meningioma than men. Like some breast tumors, meningiomas have also been found to be sensitive to estrogen and/or progesterone. Sensitivity refers to the tumor cells having receptors for certain hormones, and responding to those hormones. In the case of some estrogen-sensitive breast cancers, the estrogen increases the growth of the tumor.

This case was in Australia. The patient had been on estrogen and an anti androgen (cyproterone acetate), and had had genital surgery years before. Her tumor was benign, though sensitive to progesterone and estrogen, and was surgically removed. Unusually, her tumor came back and was removed again. She underwent radiation treatment. She is reported to have chosen to stop hormones and has made a full recovery.

Whether hormone therapy influences the growth of meningiomas is unknown. So far, the data are mixed and there is no consensus in the medical community. The other two case reports continued hormone therapy with no recurrence of the tumor. To stay on the safe side, however, the authors recommend that hormone therapy be discontinued upon diagnosis of a meningioma. They also suggest that a history of meningioma may be a contraindication for starting hormone therapy.

All individuals, trans or cis, should seek medical advice if they have any neurological symptoms. This includes symptoms associated with meningiomas such as headaches, seizures, blurred vision, double vision, weakness in arms or legs, numbness, or speech problems.

This case report was published in International Journal of Transgenderism. The abstract is publicly available.