Introduction:

Cyproterone acetate (CPA) is a medication commonly used in gender-affirming care for transgender women and individuals with hyperandrogenism. While Cyproterone is effective in suppressing testosterone levels and addressing the masculinising effects of androgens, it is essential to be aware of its potential impact on liver health. This article aims to provide an overview of the relationship between cyproterone and liver disease, helping individuals and healthcare providers make informed decisions.

Cyproterone Acetate and its Uses:

Cyproterone acetate is a synthetic steroidal antiandrogen. It is primarily prescribed to reduce the effects of androgens (male sex hormones) in the body. In gender-affirming care, Cyproterone is often combined with estrogen therapy to feminise secondary sexual characteristics.

The Liver’s Role:

The liver plays a crucial role in metabolising drugs and maintaining hormonal balance in the body. It processes and eliminates various substances, including medications like cyproterone. As such, any drug, including Cyproterone, has the potential to affect liver function and should be avoided in people who have existing liver disease or fatty liver.

Cyproterone and Liver Health:

Research suggests that long-term use of cyproterone may be associated with certain liver-related risks. While the exact mechanisms are not fully understood, Cyproterone’s impact on the liver may include:

1. Hepatotoxicity: In rare cases, cyproterone has been linked to hepatotoxicity, a condition characterized by liver damage. Symptoms may include jaundice (yellowing of the skin and eyes), abdominal pain, and changes in liver enzyme levels.

2. Tumours: Some studies have reported an increased risk of benign liver tumors (hepatic adenomas) in individuals taking Cyproterone. These tumors are generally noncancerous but may require medical attention if they grow or cause symptoms.

3. Cholestasis: Cyproterone can potentially lead to cholestasis, a condition where bile flow from the liver to the intestines is impaired. This can result in symptoms like itching, dark urine, and pale stools.

4. Monitoring Liver Function:

• Individuals taking cyproterone should undergo regular liver function tests (LFTs) to assess the health of their liver. These tests measure levels of liver enzymes and other markers.
• Healthcare providers may recommend periodic imaging studies, such as abdominal ultrasounds, to monitor liver structure and detect any abnormalities.

Managing Liver Health:

To minimise potential risks associated with cyproterone and liver health:

• Regular Monitoring: Adhering to a schedule of regular liver function tests is essential. These tests can help detect liver-related issues at an early stage.
• Dosage Considerations: Healthcare providers should carefully prescribe cyproterone, taking into account individual health factors. Lower dosages may be recommended when possible.
• Alternative Medications: In some cases, alternative antiandrogen medications with a lower risk of liver-related issues may be considered.
• Lifestyle Choices: Maintaining a healthy lifestyle, including avoiding excessive alcohol consumption and maintaining a balanced diet, can support liver health. Liver function tests (LFTs) can be affected by heavy drinking, even if it’s just for one night. When a person drinks alcohol, their liver metabolizes it, which can cause alterations in specific markers that are measured in liver function tests. However, it is recommended to stop cyproterone if your liver markers are affected and choose another antiandrogen. 

Conclusion:

Cyproterone acetate is a valuable tool in gender-affirming care, but its use should be accompanied by careful monitoring of liver health. Individuals taking cyproterone should be vigilant about routine liver function tests and should promptly report any unusual symptoms to their healthcare providers. By staying informed and proactive, individuals can continue their gender-affirming journey while prioritizing their overall well-being. It is crucial for healthcare providers to weigh the benefits and risks of cyproterone when considering its use in treatment plans.