Cyproterone acetate (CPA) is an antiandrogen that may be used in combination with estradiol in gender reaffirmation therapy...However, its effect appears to be delayed, indicating that cessation alone is suboptimal in cases causing significant mass effect and symptomatology. In such cases, early surgical intervention should be considered.
Our cases highlight the real-world risk of this likely underreported adverse effect and underscore the importance of clinician vigilance for neurological sequelae. We suggest using the lowest dose of CPA that maintains adequate androgen suppression, with consideration of alternative anti-androgens where appropriate.
Finally, we show by exome analysis of breast tumors and meninges that hormone impregnation promotes breast tumor formation without additional somatic oncogenic mutation but is associated with an increased mutational burden on Pik3ca-mutant background. Taken together, these results tend to suggest a prominent role of Pik3ca mutations over hormone impregnation in meningioma tumorigenesis, the exact effect of the latter is still to be discovered.