Pride Month 2026: Understanding Seizure Risk and Gender-Affirming Hormone Therapy

Questions surrounding the neurologic safety of gender-affirming hormone therapy (GAHT) remain an important area of investigation, particularly as clinicians seek evidence-based guidance to inform care for transgender and gender-diverse individuals. Although concerns have been raised regarding potential neurologic adverse effects associated with GAHT, limited data are available to guide discussions surrounding seizure risk in transgender populations.¹

A recently published study in Epilepsy Research examined the association between GAHT use and seizures among transgender women using data from the 2016-2019 Healthcare Cost and Utilization Project National Inpatient Sample. In the analysis, conducted by lead author Medha Reddy, MD, neurology resident at the University of Chicago, and colleagues,researchers identified 4765 transgender women, including 254 (5.3%) who used GAHT. Findings showed that transgender women receiving GAHT did not have significantly increased odds of seizure during inpatient hospitalization compared with transgender women not receiving hormone therapy (OR, 0.65; 95% CI, 0.16-1.78; P = .47).

In honor of Pride Month, held annually in June, NeurologyLive^® spoke with Reddy and senior author Nicole Rosendale, MD, FAAN, associate professor of neurology at the University of California, San Francisco, further about the study. The pair highlighted the lack of inclusive neurologic research involving transgender and gender-diverse populations, emphasized that the findings provide preliminary evidence supporting the neurologic safety of GAHT with respect to seizure-related hospitalizations. They also underscored the need for additional studies evaluating seizure incidence and outcomes across outpatient settings and broader transgender and gender-diverse communities.

NeurologyLive: Can you provide an overview of this study and discuss the primary objectives that guided the research?

Nicole Rosendale, MD, FAAN: There has been a dearth of studies that are inclusive of the transgender community. I think, in that setting, any information and any advancement with good intentions is really important. So, this was really an approach to try to understand the landscape of what the community needs and what the community is experiencing in neurology. There are still so many questions that we just don't have the ability to answer, given the data sources that we have, and so this was a step in the direction of trying to get a better understanding.

In particular, I was really drawn to this work because so much of the current landscape and the current conversation is really around concerns about the safety of GAHT. I think really truly investigating that in a scientifically rigorous and objective manner, and doing it in a way that comes from an understanding of how to do this well scientifically, is really important. It's not only important for us to ensure that the community still has access to this medically necessary care, but really so that we as clinicians can help inform those conversations with the individual patients that we're caring for, and that we're not doing practices that are not evidence-based and are potentially creating harm.

Medha Reddy, MD: This was a project that was, like so many of mine, really born out of my interactions with patients. It was one of my first weeks on a neurology rotation as a medical student, where someone had come in during their transition process with a subsequent seizure and was really concerned about how this influenced their transition.

Looking at the literature at the time, as Dr. Rosendale spoke to, we didn't have much to really offer in terms of guidance and how to help them navigate not only those questions, but this larger journey that they were going on. So, that was really what inspired the project, and I'm really hoping that this is a first, and a very important, step for us in learning a little bit more about the safety of GAHT in neurologic care.

Can you summarize the main findings from your analysis and discuss the potential implications of these results for clinicians caring for transgender and gender-diverse patients?

Reddy: Our methodology allowed us to look at all inpatient hospitalizations as part of a national hospital sample that essentially includes thousands of visits across the country. We were able to see, in individuals who were using GAHT, whether there was an increased risk of experiencing an inpatient hospitalization for seizures versus their transgender counterparts who were not using GAHT, as well as their cisgender counterparts.

Ultimately, through our analysis, we were able to draw the conclusion that there was no increased risk associated with using GAHT in terms of having an inpatient hospitalization for a seizure. While this is more targeted toward the hospital setting, our hope, as I mentioned earlier, is that this is a first step, and that we'll be able to replicate similar studies in ambulatory settings to broaden this conclusion further.

Rosendale: I think the implications of this are really, again, that GAHT does not increase the risk of seizure in hospitalization, or hospitalization for seizure, in transgender women who are using GAHT. As Dr. Reddy mentioned, I think that this is a first step.

There are many parts of the community that we still need to understand—transgender men, for example, folks who aren't in the transgender binary, so people who are genderqueer, nonbinary, etc. There are so many questions that we need to understand. Then, outside of the hospital setting, similarly, in the ambulatory setting, really understanding if there is any connection or association between use of GAHT and seizure incidence, management, etc.

So, there's still far more work to be done, but I do think that this is an important step, particularly in the hospital setting where, as Dr. Reddy mentioned, from the objective and motivation for this study, these questions do come up. I think in the hospital setting, this question is important to move forward because there tends to be more urgency in answering it for hospitalized patients. So, I do think that this was an important step in the right direction.

Based on these findings, what additional research is needed to further understand the relationship between GAHT and neurologic outcomes?

Rosendale: Oh, there's so much. Certainly, I do think that this field still needs so much work to be done, and in particular, I think that the work that does need to be done really needs to be done in collaboration with the community so that it is scientifically rigorous, yet respectful, and informs really high-quality, evidence-based care. I think that is a huge impetus.

Outside of the questions of GAHT, there are a number of different health-related needs that the community has, whether that is in the field of epilepsy or beyond. So, I think really broadening our perspective, and not as clinicians and researchers hyper-focusing on GAHT as this entity that is the end-all, be-all, is important.

There's so much more that goes into appropriately caring for trans and gender-diverse individuals, and there's so much more research that needs to be done that isn't exclusively focused on the hormone question. So, I really would encourage other researchers to think about being very inclusive in how they're thinking about sex and gender, how they're recruiting, and how they're asking demographic questions, and really creating a research culture that is inclusive and thoughtful so that we can really advance the field.

Reddy: I think the only thing I'll add is that there's so much that's happening in the world outside of the hospital with GAHT. As Dr. Rosendale mentioned, we hope that further research in this field serves as a vehicle for clinicians who want to stand up and serve as allies to our patients and their health goals. We really hope that other clinicians take up this call to action in research and also in implementing these findings by sharing them with their patients.

Transcript edited for clarity. Click here for more of our coverage on epilepsy.

REFERENCES
1. Reddy M, Sacknovitz A, Williamson J, et al. Examining the association between gender affirming hormone therapy and seizures during inpatient hospitalization among transgender women in the United States. Epilepsy Res. 2026;223:107776. doi:10.1016/j.eplepsyres.2026.107776