From Hormones to Pancreatitis: A Case of Estrogen-Induced Hypertriglyceridermia
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Publication Date
2025
Abstract
Introduction: Hormonal replacement therapy (HRT) for transgender women, also known as gender-affirming hormone therapy (GAHT), is designed to align physical characteristics with gender identity. Potential risk associated with feminizing hormone therapy with estradiol include venous thromboembolism, cardiovascular disease and changes in lipid profile. We present a case of estrogen replacement therapy induced hypertriglyceridemia causing acute pancreatitis in a young transgender woman. Case Presentation: A 30-year-old transgender woman on estrogen and progesterone replacement therapy, as well as history of hypertension and MELAS syndrome admitted with 2-day history epigastric pain, nausea, and decreased urination. Notably, her estradiol dosage had recently increased from 6 mg to 8 mg five months prior. Discussion: Acute pancreatitis is a potentially life-threatening condition with significant morbidity and mortality, often resulting from gallstones or alcohol use. Hypertriglyceridemia, though a less common cause, can trigger pancreatitis by increasing free fatty acid production, leading to pancreatic inflammation and injury. The underlying mechanisms of hypertriglyceridemia-induced pancreatitis are not fully understood but are believed to involve hydrolysis of triglycerides into toxic free fatty acids, causing direct pancreatic injury, endothelial damage, calcium overload, and a pronounced inflammatory response. Estrogen therapy, particularly oral formulations, has been associated with elevated plasma triglyceride levels due to its effects on hepatic lipid metabolism. In this case, estrogen-induced hypertriglyceridemia was the likely precipitant of acute pancreatitis, exacerbated by the patient’s pre-existing conditions, including MELAS syndrome and hypertension. The increase in estradiol dosage may have further contributed to the rise in triglyceride levels. Clinicians should routinely monitor triglyceride levels in transgender women receiving estrogen therapy, especially in those with predisposing conditions. Transdermal estradiol, as used in this patient post-discharge, may pose a lower risk of hypertriglyceridemia due to reduced first-pass hepatic metabolism. Early intervention, lipid control, and switching to safer formulations can mitigate the risk of serious complications like pancreatitis.
Specialty/Research Institute
Graduate Medical Education
