Hormone Therapy Considerations in Liver Cancer

Introduction to Hormone Pellet Therapy Risks

Exogenous estradiol can promote hormone-dependent cancer progression in patients with liver cancer, based on data from cisgender women on hormone replacement therapy, as noted by the American Cancer Society 1, 2
Testosterone's effects are conflicting, with early preclinical studies suggesting high-concentration testosterone may increase estrogen-dependent cancer risk through aromatization to estrogen, while other data suggest androgen receptor activation might actually prevent hormonally-driven cancers, according to the American Cancer Society 1, 2

The American Association for the Study of Liver Diseases notes menopausal hormone therapy can promote hepatocellular adenoma (HCA) in patients with liver disease 5, 6
Estradiol products carry warnings about systemic absorption, and all systemic estrogen warnings apply, as stated by the American College of Gastroenterology 5, 6
Testosterone therapy in cirrhotic patients carries relative contraindications, including personal or family history of HCC, history of prostate cancer, and thrombophilia, as recommended by the American Association for the Study of Liver Diseases 3

Up to 35% of transgender individuals surveyed would continue hormone therapy despite a new hormone-dependent cancer diagnosis, highlighting the importance of patient autonomy and informed decision-making, as noted by the American Cancer Society 1, 2
A tailored conversation is mandatory, weighing what is known about GAHT and hormone-sensitive cancers against the patient's unique experiences and goals, according to the American Cancer Society 1, 2

Hematocrit levels should be monitored for polycythemia in patients undergoing hormone therapy, as recommended by the American Association for the Study of Liver Diseases 3
Liver function tests should be performed due to potential hepatotoxicity in patients undergoing hormone therapy, as stated by the American Association for the Study of Liver Diseases 3
Lipid profile should be monitored in patients undergoing hormone therapy, as recommended by the American Association for the Study of Liver Diseases 3

Transdermal testosterone is strongly preferred over oral formulations to avoid hepatotoxic effects, as recommended by the American Association for the Study of Liver Diseases 3
Oral testosterone is strongly discouraged due to hepatotoxicity and hepatic neoplasia risk, as stated by the American College of Gastroenterology 4

For transgender patients with liver cancer, conduct detailed informed consent discussion about theoretical cancer promotion risks, as recommended by the American Cancer Society 1, 2
For non-transgender patients with liver cancer, recommend against hormone pellet therapy given lack of life-saving mental health indication, as stated by the American Association for the Study of Liver Diseases 5, 6, 3