Ischemic stroke in a man using estrogen.

Ischemic cerebrovascular disease has been associated with oral contraceptives but not standard hormone replacement in women. It is unknown whether or not estrogen therapy in a male is associated with an increased risk of stroke. We report a single case of a genetic male taking high doses of estrogen and progesterone who suffered a stroke. A 46-year-old man was using high doses of estrogen and progesterone while awaiting surgical gender reassignment. He had suffered a deep venous thrombosis 1 year prior to presentation. He developed an acute left visual field cut, left neglect, and left hemiparesis. Neuroimaging disclosed a large right hemispheric stroke. A complete evaluation did not reveal an etiology. No identifiable cause could be found for this patient's stroke, except for his high-dose hormonal therapy. Physicians treating male-to-female transsexuals need to be aware of this rare complication of hormone therapy.