# Danazol's use for menstrual suppression in transgender individuals: A retrospective multi-site cohort study.

- **DOI:** [10.1177/17455057241265081](https://doi.org/10.1177/17455057241265081)
- **Rating:** Sound (3.3 out of 5)
- **Verdict:** A first-in-kind clinical cohort identifies danazol as a plausible menstrual-suppression option, but nonstandardized retrospective outcomes prevent practice-confirming conclusions.
- **Framework version:** v5.9
- **Pipeline version:** v0.4
- **Evaluation date:** 2026-09-18
- **Evaluation page:** https://www.nabu.science/paper/10.1177%2F17455057241265081

## Key claims

1. Our data suggest that danazol may be a plausible option for menstrual suppression in transgender and nonbinary patients.
   - Support: Tentative
   - Type: Primary finding
   - Basis: a cautious clinical implication drawn from a small, uncontrolled retrospective cohort
   - Location: Conclusion
2. At follow-up, 84.9% of transgender patients (N = 28) reported becoming amenorrheic.
   - Support: Supported
   - Type: Secondary
   - Basis: a directly observed descriptive proportion with limited follow-up and no comparator
   - Location: Results, amenorrhea paragraph
3. Most transgender and nonbinary patients on danazol for menstrual suppression remained on it at their most recent follow-up visit.
   - Support: Supported
   - Type: Secondary
   - Basis: continuation was directly abstracted, though follow-up duration varied across patients
   - Location: Abstract; Results, discontinuation paragraph
4. Many charts noted improvements in gender dysphoria, pelvic pain, dysmenorrhea, endometriosis, and heavy menstrual bleeding.
   - Support: Tentative
   - Type: Secondary
   - Basis: nonstandardized chart outcomes with unclear follow-up denominators for selected symptoms
   - Location: Abstract; Results, symptom-outcome paragraphs

## Strengths

- **First population-specific evidence for danazol** The study documents a previously unstudied use of danazol for menstrual suppression in transgender and nonbinary patients, including amenorrhea, persistence, dosing, and symptoms.
  - Dimension: contribution
  - Location: Introduction, final paragraph; Results, Tables 2–3 narrative
- **Descriptive design matches primary objective** The multisite chart review directly characterizes outcomes among danazol users and reports medians, interquartile ranges, frequencies, and varying denominators rather than presenting adjusted causal estimates.
  - Dimension: methodological rigour
  - Location: Methods; Statistical Analysis
- **Limitations linked to interpretation** The Discussion explains how retrospective documentation, limited follow-up, a predominantly White sample, and attention bias affect generalizability and confidence in symptom estimates.
  - Dimension: positioning
  - Location: Discussion, limitations paragraph

## Limitations

- **Nonstandardized documentation shapes key outcomes** Symptom improvement and side effects were abstracted from clinical notes without standardized measures, leaving estimates vulnerable to documentation and attention bias.
  - Dimension: methodological rigour
  - Location: Discussion, limitations paragraph
- **No comparator supports treatment positioning** The cohort includes no concurrent alternative menstrual-suppression arm, so the suggestion that danazol may be more attractive than other treatments is not directly tested.
  - Dimension: reporting
  - Location: Conclusion, paragraph 1
- **Selected outcome denominators remain unclear** The gender-dysphoria and pelvic-pain percentages imply smaller follow-up subsets than the baseline indication totals, but those follow-up denominators are not stated at the results.
  - Dimension: methodological rigour
  - Location: Results, gender-dysphoria and pelvic-pain paragraph

## Reliability checks

Caveats (4 of 4 checks).

- **Internal coherence:** Noted. The main cohort totals and headline amenorrhea and continuation figures are coherent, but selected symptom-improvement percentages do not state their follow-up denominators transparently. These appear reconcilable through implied denominators rather than constituting demonstrated contradictions.
- **Research conduct:** Clean. IRB approval, exempt status, consent waivers, and deidentification are declared in Methods. The generic online-supplement statement cannot be inspected from the supplied material and is recorded as an assessability gap, not a reliability concern.
- **Reference integrity:** Clean. 21 of 21 checkable references verified
  - 23 references in manuscript
  - 2 are books, websites or datasets — counted, but not index-checkable
  - References not verified automatically are resolved manually within 24 hours.

## Post-publication record

- **Status:** Clean
- **Summary:** No retraction or expression of concern found in Crossref (includes Retraction Watch).
- **Last checked:** 2026-10-17