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Neurological Rehabilitation

Restarting Hormone Therapy in Transgender Patient after Ruptured Arteriovenous Malformation: A Case Report

Saturday, October 25, 2025
12:00 PM - 1:30 PM MT
Location: Kiosk 5

    Primary Author(s)

  • MH

    Morgan Howells-Resendez, MD (she/her/hers)

    Resident Physician
    ECU Health (Vidant Medical Center/East Carolina University) PM&R Program
    Greenville, North Carolina

    • Poster Presenter(s)

  • ES

    Emma Spilsted, MD

    Resident Physician
    East Carolina University Medical Center
    Greenville, North Carolina

    • Co-Author(s)

  • FB

    Frandrea L. Brown, PhD

    Marriage & Family Therapy Supervisor
    ECU Health (Vidant Medical Center/East Carolina University) PM&R Program
    Greenville, North Carolina

  • RL

    Robert Lombard, MD

    Assistant Clinical Professor
    ECU Health (Vidant Medical Center/East Carolina University) PM&R Program
    Grimesland, North Carolina

Disclosure(s):
Morgan Howells-Resendez, MD: No financial relationships to disclose
Emma Spilsted, MD: No financial relationships to disclose
Robert Lombard, MD: No financial relationships to disclose
Case Diagnosis: A 69 year-old transgender male-to-female (MTF) patient presented with intracranial hemorrhage secondary to ruptured arteriovenous malformation (AVM) and was restarted on gender affirming hormone treatments.

Case Description or Program Description: A 69 year-old transgender MTF patient presented with new onset right hemiparesis. She was found to have ruptured AVM with herniation, and went for AVM embolization and resection. Patient was admitted to inpatient rehabilitation where her wife provided information about patient’s home Estradiol treatments. It had been 4 weeks since last injection, and she was showing signs of deepening voice and facial hair growth. These were accompanied by worsening of her pre-existing depression. During a discussion with medical-family therapy, patient expressed a desire to restart hormone therapy. Given recent intracranial bleed combined with inherent risk of deep venous thrombosis associated with hospitalization, the interdisciplinary care team had a discussion regarding the risks of restarting hormone treatment with known coagulation risks. Ultimately, the benefits far outweighed the risks, and hormone replacement was restarted.

Setting: Inpatient Rehabilitation

Assessment/Results: Accommodating this patient’s gender affirming care led to improved trust in the interdisciplinary team, leading to improved participation and better functional outcomes. She made significant gains in therapies and was successfully discharged home where her endocrinologist continued prescribing estradiol injections.

Discussion (relevance): Nearly 20% of transgender patients are denied access to healthcare, and the rates of depression and suicidal ideation are profoundly increased in this population. It is important to recognize the vulnerabilities inherently associated with certain patient populations, so that the health care team can work with patients to build trust. It is also important to note that rates of depression following initiation of gender affirming care drop drastically. Using an interdisciplinary approach allows the healthcare team to provide more integrated and patient-centered care.

Conclusions: Supporting gender affirming care can improve functional and psychosocial outcomes for patients in inpatient rehabilitation facilities.