Intracranial Hypertension in Transgender Patients

Idiopathic intracranial hypertension (IIH) is a potentially blinding condition characterized by increased intracranial pressure, papilledema, headaches, and vision loss (1). The role of exogenous sex hormones in the development of IIH is controversial (2). Five cases of IIH occurring in transgender patients undergoing female-to-male (FTM) transition with exogenous testosterone have been reported, suggestive of a causal relationship between exogenous testosterone use and IIH (3). In 3 of the 5 patients, exogenous testosterone was altered or discontinued. We report 2 additional cases in transgender patients: one in a patient undergoing FTM transition and the other in a patient undergoing male-to-female (MTF) transition. In both, the manifestations of intracranial hypertension were managed entirely without any modification of the patient's hormonal therapies, demonstrating that gender-affirming hormonal therapy can be safely continued in transgender patients with IIH.