Epilepsy Management in Transgender and Gender Diverse People

Purpose of review The goal of this review is to outline important topics in epilepsy management for transgender and gender diverse individuals. Specifically, we describe the common gender-affirming hormone treatment regimens, how these changes in estrogens and androgens may affect seizure threshold and anti-seizure medications, and how anti-seizure medications may in turn impact hormone levels.Recent findings Although data are mixed, most studies point to proconvulsant properties of estrogen and anticonvulsant properties of progesterone and testosterone, raising the possibility of an increased risk of breakthrough seizures when starting on feminizing gender-affirming hormone treatment. Feminizing hormone regimens containing estrogen are likely to significantly decrease serum concentration of lamotrigine. Enzyme-inducing anti-seizure medications decrease circulating levels of estrogens and androgens, which may potentially decrease the efficacy of gender-affirming hormone treatments.Summary While a general approach to the care of transgender individuals with epilepsy may be extrapolated from existing studies on hormonal interactions in cisgender individuals, there is a clear need for further research more closely examining the complex interactions between epilepsy, anti-seizure medications, and gender-affirming hormone therapy in transgender and gender diverse individuals.