What are the risks and benefits of HRT for patients who have had gonadectomies because of an anomaly in sex development?
The potential sequella of HRT (heart disease, breast cancer, stroke, pulmonary embolism, etc.) in these patients is unknown, as are the long-term potential benefits (reduced fracture rate, colon cancer reduction, quality of life). The reason for the uncertainty is itself pretty clear; there are few if any relevant studies. The use of HRT in patients who have had a gonadectomy because of an anomaly in sex development or in patients who were born without functioning gonads has not been well studied in any age group. There are no randomized controlled trials looking at mortality or morbidity and the observational data is scant. The best evidence has to be drawn from other conditions and the parallels are not complete. This is the potentially relevant data we can glean from the available studies: Patients with hypothalamic hypoestrogenic amenorrhea from exercise or weight loss do have low estrogen levels and subsequent losses of bone density. Estrogen has protective effect in the most seri
