The Clot Thickens: A Case of Acute Severe CVST Shortly Following Testosterone Therapy in a Young Transgender Man

Background: Cerebral venous sinus thrombosis (CVST) is a rare but potentially life-threatening condition, often associated with prothrombotic risk factors. The impact of gender-affirming hormone therapy on thrombotic risk in transgender individuals remains underexplored. Case Presentation: An 18-year-old transgender man, recently commenced on testosterone therapy, presented with a four-week history of progressive headache, photophobia, diplopia, and visual impairment. Examination revealed left lateral gaze palsy and grade 4 papilloedema. Imaging confirmed extensive CVST involving the superior sagittal, straight, left transverse, left sigmoid sinuses, and left internal jugular vein. Despite anticoagulation and acetazolamide, the patient required a lumbar-peritoneal shunt for worsening papilloedema. Post-operative improvement was noted, though residual visual deficits persisted. Long-term management included anticoagulation, visual monitoring, and discontinuation of testosterone therapy. Conclusions: This case highlights the potential thrombotic risks associated with testosterone therapy, especially during the initiation phase. Early recognition, multidisciplinary care, and ongoing surveillance are vital. Further research is needed to establish evidence-based guidelines for thrombotic risk assessment and management in transgender patients receiving hormone therapy.