Title:
Importance of Medication Reconciliation in Treatment of a Transgender Male Patient With Bipolar Disorder Undergoing Gender-affirming Hormone Therapy

Authors:
Ellie Rapp, Akuti Khanna, Luis Rodriguez, Özge Özkan, Aditi Pajiyar, Himani J. Suthar, Arushi Chandra Parikh, and Parinda Parikh, USA

Abstract:

Bipolar disorder is characterized by depressive and manic symptoms that occur in cycles, and higher prevalence rates have been reported in transgender populations. Female-to-male (FTM) and transmasculine people sometimes opt for gender-affirming hormone therapy (GAHT) via exogenous testosterone, a hormone responsible for body and brain masculinization. However, testosterone can exacerbate mental illness symptoms or trigger a depressive/manic episode, especially in the presence of mood disorder. A 38-year-old FTM man with stable bipolar disorder presented with symptoms of mania after increasing the dosage of his GAHT, which was not reported to his psychiatrist. Within a few days, the patient was hospitalized and required initiation of antipsychotic treatment and cessation of testosterone therapy. A lack of medical reconciliation and knowledge of GAHT interactions with neural circuitry led to an avoidable, significant consequence. While the neurobiological connections of testosterone GAHT, bipolar disorder, and transgenderism are still unclear, overlapping neuronal mechanisms could have warranted a severer consequence for the patient. This case highlights the importance of medication reconciliation and how clinicians should recognize potential implications of GAHT and mood disorder within the FTM/transmasculine population.

DOI: http://dx.doi.org/10.51505/ijmshr.2026.10307