Acute Aortic Dissection in a Postmenopausal Female in the Setting of Parenteral Testosterone, Estradiol, and Progesterone Therapy

ABSTRACT Objective The FDA has not approved the use of testosterone in women. However, parenteral testosterone is being used off-label in free standing clinics throughout America. The recent multi-ethnic study of atherosclerosis (MESA) population study showed that postmenopausal women with a higher testosterone/estradiol ratio had a higher incident of cardiovascular disease. This is a case of a postmenopausal woman who dissected her thoracic aorta after 8 months of parenteral testosterone. Methods The clinical examination, radiographic, and laboratory findings of a patient are presented along with a review of the literature. Results A heathy postmenopausal women, whose only risk factor was parenteral testosterone, developed a dissection of her entire thoracic aorta. Conclusion The MESA study and other conflicting publications on cardiovascular events in transgender patients receiving exogenous androgens indicates the need for further investigation to determine the safety of testosterone therapy for women and its possible role in contributing to aortic disease.