The interplay between the endocrine system, tumour growth, and pharmacology is a subject that has attracted a lot of interest in the medical community throughout the past few years. In particular, the role of exogenous progestogens (synthetic hormones that are not naturally produced by the body) in benign brain tumour development has been a puzzle for scientists since the potential correlation between the two was first documented in medical case notes decades ago. The inspiration for my Innovative Writing Report came from my summer work experience, where I worked alongside doctors in a surgical ward in France for a month. This was a ward that dealt with a large volume of meningioma resections, which is a surgical procedure that aims to remove a specific kind of benign brain tumour growing in the meninges (membranes that line the brain). According to the doctors’ experiences, many of the hospital’s meningioma patients had one factor in common: a long-term prescription for Androcur, a hormonal medication containing cyproterone acetate. This is a highly potent progestogen medication with a wide variety of indications, that is mainly used as an antiandrogen, for birth control, or as one of multiple options for medical transition.

Although it was relatively common knowledge in our clinical setting that there was some sort of link between the two, doctors advised that there was no conclusive evidence or formal research to prove causation, and therefore there was no conclusive information to give to patients. Indeed, formal literature on the subject (such as that recently published by Weill, et al. in the BMJ) is only beginning to emerge, and I wanted to contribute to this discovery by presenting a little-known medical problem that might affect a very wide percentage of our population.

My report aimed to provide an in-depth review of existing literature and case notes to present this phenomenon to a wider audience, whose life this may affect. It was fascinating to research the possible biological effect of sex hormones on brain tumours, since I had previously thought of these two physiological systems as working in isolation when they are in fact deeply intertwined. The overall goal of the study was to examine what factors contributed to higher risk of meningioma for patients taking these medications, present the existing literature concisely for prescribers, and generate recommendations for future research. Having taken classes in evidence-based medicine, I know the importance of research in informing safe clinical decisions, and wanted to contribute to safer prescribing practices, whether in France or the UK.