From the Research
The management of transaminitis in patients taking progesterone should prioritize a stepwise approach, focusing on the severity of liver enzyme elevation, and considering the potential benefits and risks of progesterone therapy, as suggested by recent studies such as 1. When managing transaminitis in patients on progesterone, it's crucial to assess the severity of liver enzyme elevation.
- For mild elevations (less than 3 times the upper limit of normal), continued monitoring with repeat liver function tests every 2-4 weeks may be appropriate while maintaining the current progesterone dose.
- For moderate elevations (3-5 times normal), dose reduction should be considered, typically by 50%, with close monitoring every 1-2 weeks.
- In cases of severe elevation (greater than 5 times normal) or if symptoms of liver dysfunction develop (jaundice, abdominal pain, fatigue), progesterone should be temporarily discontinued and alternative treatments explored. The underlying mechanism for progesterone-induced transaminitis involves altered hepatic metabolism and potential cholestatic effects, as noted in various studies, including 2 which discusses the effects of hormone replacement therapy on liver enzyme levels. During management, it's essential to rule out other causes of liver enzyme elevation such as viral hepatitis, alcohol consumption, or other hepatotoxic medications. If progesterone therapy must be continued for clinical reasons despite mild to moderate elevations, using the lowest effective dose and potentially switching to a different formulation (oral to transdermal, for example) may help minimize hepatic effects, as suggested by the potential benefits of progesterone outlined in 3 and 1. Consultation with a gastroenterologist or hepatologist is warranted for persistent or severe cases to guide further management and explore alternative treatment options, considering the most recent evidence on the health risks and benefits of progesterone in different populations, such as transgender women, as discussed in 1.