RESUMO
BACKGROUND: There is insufficient research on how gender-affirming hormone therapy (GAHT) affects body fat modifications in transwomen from China. It is unclear whether hormone therapy affects the prevalence of obesity and blood lipid levels within this population. The current research aimed to assess how GAHT and treatment duration had an impact on the change in and redistribution of body fat in Chinese transwomen. METHODS: This study included 40 transwomen who had not received GAHT and 59 who had. Body fat, blood lipid, and blood glucose levels were measured. GAHT is mainly a pharmacologic (estrogen and anti-androgen) treatment. The study also stratified participants based on the duration of GAHT to assess its impact on body fat distribution. The duration of GAHT was within one year, one to two years, two to three years, or more than three years. RESULTS: After receiving GAHT, total body fat increased by 19.65%, and the percentage of body fat increased by 17.63%. The arm, corrected leg, and leg regions showed significant increases in fat content (+ 24.02%, + 50.69%, and + 41.47%, respectively) and percentage (+ 25.19%, + 34.90%, and + 30.39%, respectively). The total visceral fat content decreased (-37.49%). Based on the diagnostic standards for a body mass index ≥ 28 or total body fat percentage ≥ 25% or 30%, the chance of developing obesity did not change significantly. Blood glucose levels significantly increased (+ 12.31%). Total cholesterol levels (-10.45%) decreased significantly. Fat changes in those who received GAHT for one to two years were significantly different from those who did not receive GAHT. CONCLUSION: After receiving GAHT, total body fat and regional fat increased in Chinese transwomen, and the body fat distribution changed from masculine to feminine, especially during the first two years. However, neither the increase in total body fat percentage nor the decrease in visceral fat content didn't bring about significant changes in the incidence of obesity, nor did triglycerides or low-density lipoprotein-cholesterol.
Assuntos
Pessoas Transgênero , Adulto , Feminino , Humanos , Masculino , Tecido Adiposo/efeitos dos fármacos , Tecido Adiposo/metabolismo , Povo Asiático , Glicemia/metabolismo , Distribuição da Gordura Corporal , Índice de Massa Corporal , Estudos de Casos e Controles , China/epidemiologia , População do Leste Asiático , Estrogênios/sangue , Gordura Intra-Abdominal/efeitos dos fármacos , Gordura Intra-Abdominal/metabolismo , Obesidade/sangue , Estudos Retrospectivos , Procedimentos de Readequação Sexual , Transexualidade/tratamento farmacológico , Transexualidade/sangueRESUMO
PURPOSE: Gender affirming hormone treatment (GAHT) results in measurable changes to anthropomorphic, biochemical and hormonal variables that are important to patients and their health care professionals to guide treatment. This study sought to quantify changes which occur in response to initiation of GAHT. METHODS: We performed a retrospective cohort study of outcomes in transgender and gender diverse (TGD) patients starting GAHT. The primary outcome was proportion of patients and time required to achieve optimal hormone levels after commencement of GAHT. Additional analyses were performed to assess whether clinical and biochemical factors were associated with likelihood of achieving target hormone levels. RESULTS: 345 patients were included. Among 154 transmasculine individuals, 116 (75%) achieved a testosterone level >10 nmol/L during follow-up at a median of 4-months (IQR 4-9). No clinical or biochemical factors were significantly associated with likelihood of reaching therapeutic testosterone concentrations in transmen. Among 191 transfeminine individuals, 131 (72%) achieved a testosterone level <2.0 nmol/L during follow-up at a median of 4-months (IQR 3-9). Factors associated with increased likelihood of testosterone suppression were use of subdermal estradiol implants as well as cyproterone acetate as an androgen antagonist. Changes in differing directions were observed during repeated measures of lipids, liver function, and blood count between transmasculine and transfeminine individuals, reflecting the important effects of testosterone and estradiol on biochemical tests ordered as part of routine clinical care. CONCLUSION: Most TGD patients achieve target testosterone levels within 9 months of GAHT initiation. Adverse effects of GAHT are rare, and are usually mild.
Assuntos
Testosterona , Pessoas Transgênero , Humanos , Estudos Retrospectivos , Feminino , Masculino , Adulto , Testosterona/sangue , Testosterona/uso terapêutico , Terapia de Reposição Hormonal/métodos , Acetato de Ciproterona/uso terapêutico , Acetato de Ciproterona/efeitos adversos , Resultado do Tratamento , Estradiol/sangue , Procedimentos de Readequação Sexual/métodos , Transexualidade/tratamento farmacológico , Transexualidade/sangue , Adulto Jovem , Pessoa de Meia-Idade , Antagonistas de Androgênios/uso terapêutico , Antagonistas de Androgênios/efeitos adversos , Estudos de Coortes , Disforia de Gênero/tratamento farmacológicoRESUMO
RESEARCH QUESTION: What are the hormonal and ovarian histological effects of a gender affirming hormonal therapy in assigned female at birth (AFAB) transgender people? DESIGN: Prospective observational study of 70 AFAB transgender people taking testosterone therapy before gender-affirming surgery (hystero-oophorectomy). A gynaecological ultrasonographic scan was undertaken and serum hormone concentrations measured, including anti-Müllerian hormone (AMH) and androgenic profile. Histological ovarian evaluation was assessed in both ovaries, including the developmental stages of the follicles. RESULTS: The mean age of the population was 27.7+/-5.14 years. The main biochemical parameters were total testosterone levels 781.5 ± 325.9 ng/dl; AMH levels 3.2 ± 1.4 ng/ml; FSH and LH levels 4.9 ± 2.5 IU/l and 3.9 ± 2.9 IU/l, respectively; and oestradiol values 47.6 ± 13.7 pg/ml. Fifty-five AFAB underwent gynaecological ultrasound before surgery and antral follicles were found in 43 out of 47 ultrasounds (91.5%) (without the presence of a dominant follicle or corpus luteum). Histological follicles were mostly in the primordial stage (88.0) and 3.3% were atretic. The thickness of the tunica albuginea was widely heterogeneous (range 0.15-1.45 mm) and luteinization of the stromal cells was observed in 68.6% of the samples. A negative correlation between testosterone levels and total antral follicles was found (Rs= -0.306, Pâ¯=â¯0.029). CONCLUSIONS: AFAB transgender people taking testosterone therapy show cortical follicle distribution in the range previously reported in fertile cisgender women of reproductive age. The follicular population may not be altered as a result of the gender-affirming hormonal therapy, although some cortical and stromal changes have been observed.
Assuntos
Hormônios/análise , Ovário/patologia , Procedimentos de Readequação Sexual , Testosterona/uso terapêutico , Transexualidade/terapia , Adulto , Feminino , Terapia de Reposição Hormonal , Hormônios/sangue , Humanos , Masculino , Ovário/efeitos dos fármacos , Sexo , Espanha/epidemiologia , Testosterona/sangue , Pessoas Transgênero , Transexualidade/sangue , Transexualidade/epidemiologia , Transexualidade/patologia , Adulto JovemRESUMO
OBJECTIVES: We systemically reviewed the literature to assess how long-term testosterone suppressing gender-affirming hormone therapy influenced lean body mass (LBM), muscular area, muscular strength and haemoglobin (Hgb)/haematocrit (HCT). DESIGN: Systematic review. DATA SOURCES: Four databases (BioMed Central, PubMed, Scopus and Web of Science) were searched in April 2020 for papers from 1999 to 2020. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Eligible studies were those that measured at least one of the variables of interest, included transwomen and were written in English. RESULTS: Twenty-four studies were identified and reviewed. Transwomen experienced significant decreases in all parameters measured, with different time courses noted. After 4 months of hormone therapy, transwomen have Hgb/HCT levels equivalent to those of cisgender women. After 12 months of hormone therapy, significant decreases in measures of strength, LBM and muscle area are observed. The effects of longer duration therapy (36 months) in eliciting further decrements in these measures are unclear due to paucity of data. Notwithstanding, values for strength, LBM and muscle area in transwomen remain above those of cisgender women, even after 36 months of hormone therapy. CONCLUSION: In transwomen, hormone therapy rapidly reduces Hgb to levels seen in cisgender women. In contrast, hormone therapy decreases strength, LBM and muscle area, yet values remain above that observed in cisgender women, even after 36 months. These findings suggest that strength may be well preserved in transwomen during the first 3 years of hormone therapy.
Assuntos
Composição Corporal/efeitos dos fármacos , Hemoglobina A/efeitos dos fármacos , Força Muscular/efeitos dos fármacos , Esportes , Testosterona/antagonistas & inibidores , Pessoas Transgênero , Tecido Adiposo/efeitos dos fármacos , Antagonistas de Androgênios/farmacologia , Desempenho Atlético , Composição Corporal/fisiologia , Acetato de Ciproterona/farmacologia , Estradiol/farmacologia , Feminino , Hematócrito , Humanos , Masculino , Força Muscular/fisiologia , Músculo Esquelético/efeitos dos fármacos , Esportes/fisiologia , Fatores de Tempo , Transexualidade/sangueRESUMO
CONTEXT: As the number of transgender (trans) people (including those who are binary and/or nonbinary identified) seeking gender-affirming hormone therapy rises, endocrinologists are increasingly asked to assist with interpretation of laboratory tests. Many common laboratory tests such as hemoglobin, iron studies, cardiac troponin, and creatinine are affected by sex steroids or body size. We seek to provide a summary of the impact of feminizing and masculinizing hormone therapy on common laboratory tests and an approach to interpretation. CASES: Case scenarios discussed include 1) hemoglobin and hematocrit in a nonbinary person undergoing masculinizing hormone therapy; 2) estimation of glomerular filtration rate in a trans woman at risk of contrast-induced nephropathy; 3) prostate-specific antigen (PSA) in a trans woman; and 4) chest pain in a trans man with a cardiac troponin concentration between the reported male and female reference ranges. CONCLUSIONS: The influence of exogenous gender-affirming hormone therapy on fat and muscle distribution and other physiological changes determines interpretation of laboratory tests that have sex-specific differences. In addition to affirmative practice to ensure a patient's name, gender, and pronoun are used appropriately, we propose that once individuals have commenced gender-affirming hormone therapy, the reference range of the affirmed gender be reported (and specified by treating clinicians) except for PSA or cardiac troponin, which are dependent on organ size. While suggestions may be challenging to implement, they also represent an opportunity to lead best practice to improve the quality of care and experiences of healthcare for all trans people.
Assuntos
Técnicas de Laboratório Clínico , Transexualidade , Adulto , Idoso , Artefatos , Técnicas de Laboratório Clínico/normas , Diagnóstico Diferencial , Técnicas de Diagnóstico Endócrino/normas , Feminino , Testes de Função Cardíaca/normas , Terapia de Reposição Hormonal/efeitos adversos , Humanos , Testes de Função Renal/normas , Masculino , Pessoa de Meia-Idade , Valores de Referência , Procedimentos de Readequação Sexual/efeitos adversos , Procedimentos de Readequação Sexual/métodos , Pessoas Transgênero , Transexualidade/sangue , Transexualidade/diagnóstico , Transexualidade/patologiaRESUMO
OBJECTIVE: The impact of different combinations of long-term gender-affirming hormone therapy (GAHT) in transwomen (TW) is largely unknown. To assess the effects of 5-year administration of cyproterone acetate (CPA) or leuprolide acetate (Leu) plus transdermal or oral estradiol (E). DESIGN: Cohort study based on prospectively collected data. Fifty TW received 50 mg CPA daily orally (n = 25; CPA+E group) or 3.75 mg Leu i.m. monthly (n = 25; Leu+E group) with 1 or 2 mg E daily for 5 years. Reproductive hormones, biochemical and anthropometric parameters, body composition and bone mineral density (BMD) were assessed. RESULTS: LH, FSH and total testosterone levels were similarly and significantly suppressed in both groups. Prolactin increased only in the CPA+E group (P = 0.002). Fasting insulin resistance and glucose progressively increased in the CPA+E group only (treatment × time effect P = 0.002 and P = 0.043, respectively). Total cholesterol increased more in the Leu+E group than in the CPA+E group and HDL-cholesterol decreased in the CPA+E group (time × treatment interaction effect, P = 0.007). Lumbar and total body BMD increased in both groups after 3 years. No serious adverse events were recorded. CONCLUSIONS: Both regimens were effective in suppression of T production. CPA+E worsened the metabolic profile with a slight increase in PRL levels. All subjects presented an increase in BMD regardless of treatment. These preliminary data could have clinical implications in the choice of GAHT, in particular for those TW not requiring gender-affirming surgery.
Assuntos
Acetato de Ciproterona/administração & dosagem , Estradiol/administração & dosagem , Leuprolida/administração & dosagem , Testosterona/sangue , Transexualidade/sangue , Transexualidade/tratamento farmacológico , Adulto , Antagonistas de Androgênios/administração & dosagem , Estudos de Coortes , Esquema de Medicação , Quimioterapia Combinada , Estrogênios/administração & dosagem , Feminino , Fármacos para a Fertilidade Feminina/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Testosterona/antagonistas & inibidores , Pessoas TransgêneroRESUMO
Male-to-female transgender (MtF TG) individuals often report using illegal subcutaneous silicone injections for body feminisation. It leads to silicone dissemination and various dermatologic complications.We report the long-term complications of these feminisation procedures with blood smear examination and dermatologic examination.Between July 2015 and December 2015, 77 MtF TG consulting at Bichat Hospital (Paris, France) were included in this cross-sectional study. Blood smear examinations were performed by a trained haematologist to quantify the presence of silicone vacuoles in monocytes.All patients reported a history of massive amounts of silicone injections (mean 4 L, range 0.5-15 L). Most patients were South American (75/77, 97%). Fifty-nine (59/75, 79%) were HIV-seropositive, mostly with undetectable HIV RNA plasma levels (46/58, 80%). Clinical examinations reported dermatologic complications for all patients: lymphatic or subcutaneous migration of silicone (59%), inflammation (50%), varicose veins (39%), post-inflammatory pigmentation (20%), infection (14%) and abscesses (4%). Blood smear examination showed intracytoplasmic vacuoles containing silicone in monocytes in all patients.We did not chemically prove the silicone nature of the vacuoles. The design of this study does not allow evaluation of short-term complications that should not be minimized.Illicit massive silicone injections always induced chronic and definitive silicone blood diffusion with dermatologic complications. This study highlights the dangers and the inefficiency of clandestine esthetic surgery. There is a need for targeted information campaigns with transgender populations about silicone injections. Otherwise, these practices may persist.
Assuntos
Silicones/efeitos adversos , Dermatopatias/induzido quimicamente , Transexualidade , Adulto , Idoso , Comportamento Criminoso , Estudos Transversais , Difusão/efeitos dos fármacos , Feminino , Testes Hematológicos , Humanos , Injeções Subcutâneas/efeitos adversos , Masculino , Pessoa de Meia-Idade , Silicones/administração & dosagem , Dermatopatias/sangue , Dermatopatias/diagnóstico , Transexualidade/sangue , Adulto JovemRESUMO
Se denomina trans-varón (TV) a una persona de sexo biológico femenino con identidad de género masculino. Para adquirir caracteres sexuales y expresar un rol social semejante podría utilizarse: terapia hormonal cruzada (THC) y/o genitoplastia masculinizante. Se evaluó el perfil de seguridad a corto plazo (primer año) de la THC con las distintas formas farmacéuticas de testosterona disponibles en nuestro país. El estudio se realizó de manera retrospectiva, analizando las historias clínicas de 30 pacientes trans-varón que cumplían con los requisitos para ser incluidos. La edad media de la población fue de 27 años. La media basal de testosterona fue de 0.43 ng/ml, que luego aumentó a 6.36 ng/ml (valores normales para sexo masculino). El hematocrito incrementó de su valor basal 40.0 a 45.2% (p < 0.01) mientras la Hb de 13.6 a 15.2 g/dl (p < 0.01). El colesterol total se mantuvo estable con valores de 175 y 185 mg/dl (p = 0.81). No hubo cambios significativos en triglicéridos: 88.3 y 102 mg/dl (p = 0.08). El colesterol LDL incrementó en los primeros 6 a 12 meses de THC de 101.2 a 112.5 mg/dl (p = 0.17). A los 12 meses los niveles de colesterol HDL aumentaron de 50.1 a 52.0 mg/ dl (p < 0.01). Las enzimas hepáticas se mantuvieron estables. No existen datos en nuestro país sobre seguridad de la testosterona en TV. No tuvimos necesidad de suspender la medicación por efectos no deseados en los parámetros estudiados.
A trans-male (TM) is a biologically female person with male gender identity who wishes to acquire male sexual characteristics and fulfil a male social role. To achieve that purpose, both cross-hormonal therapy (CHT) and surgical phalloplasty can be used. We evaluated the short term (12 months) safety profile of CHT using different forms of testosterone available for prescription in Argentina. In this retrospective study, we analyzed the medical history of 30 trans-male patients fitting the inclusion criteria. The mean age of the population was 27 years. The mean basal serum level of testosterone was 0.43 ng/ml, which increased to 6.36 ng/ml (male hormonal levels). The hematocrit increased from a baseline of 40.0 to 45.2% (p < 0.01) and hemoglobin increased from 13.6 to 15.2 g/dl (p < 0.01). Total cholesterol remained stable with values of 175 and 185 mg/dl (p = 0.81). There were no significant changes in serum triglycerides: 88.3 and 102 mg/dl (p = 0.08). LDL increased in the first 6 to 12 months of CHT from 101.2 to 112.5 mg/dl (p = 0.17). At 12 months HDL levels increased from 50.1 to 52 mg/dl (p < 0.01). Hepatic enzymes remained stable. There is no available data regarding safety of testosterone use in TM in our country. In no case did we need to suspend the medication due to unwanted effects.
Assuntos
Humanos , Masculino , Feminino , Adulto , Adulto Jovem , Testosterona/uso terapêutico , Transexualidade/tratamento farmacológico , Pessoas Transgênero , Valores de Referência , Testosterona/sangue , Fatores de Tempo , Transexualidade/sangue , Triglicerídeos/sangue , Colesterol/sangue , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Estatísticas não ParamétricasRESUMO
Context: Progestins can be used to attenuate endogenous hormonal effects in late-pubertal transgender (trans) adolescents (Tanner stage B4/5 and G4/5). Currently, no data are available on the effects of progestins on the development of bone mass or body composition in trans youth. Objective: To study prospectively the evolution of body composition and bone mass in late-pubertal trans adolescents using the proandrogenic or antiandrogenic progestins lynestrenol (L) and cyproterone acetate (CA), respectively. Design and Outcome Measurements: Forty-four trans boys (Tanner B4/5) and 21 trans girls (Tanner G4/5) were treated with L or CA for 11.6 (4 to 40) and 10.6 (5 to 31) months, respectively. Anthropometry, grip strength, body composition, and bone mass, size, and density were determined by dual-energy X-ray absorptiometry and peripheral quantitative computed tomography before the start of progestin and before addition of cross-sex hormones. Results: Using L, lean mass [+3.2 kg (8.6%)] and grip strength [+3 kg (10.6%)] significantly increased, which coincided with a more masculine body shape in trans boys. Trans girls showed loss of lean mass [-2.2 kg (4.7%)], gain of fat mass [+1.5 kg (9.4%)], and decreased grip strength Z scores. CA limited normal bone expansion and impeded pubertal bone mass accrual, mostly at the lumbar spine [Z score: -0.765 to -1.145 (P = 0.002)]. L did not affect physiological bone development. Conclusion: Proandrogenic and antiandrogenic progestins induce body composition changes in line with the desired appearance within 1 year of treatment. Bone health, especially at the lumbar spine, is of concern in trans girls, as bone mass accrual is severely affected by androgen suppressive therapy.
Assuntos
Composição Corporal/efeitos dos fármacos , Densidade Óssea/efeitos dos fármacos , Desenvolvimento Ósseo/fisiologia , Acetato de Ciproterona/uso terapêutico , Linestrenol/uso terapêutico , Pessoas Transgênero , Transexualidade/tratamento farmacológico , Absorciometria de Fóton , Adolescente , Composição Corporal/fisiologia , Densidade Óssea/fisiologia , Criança , Acetato de Ciproterona/administração & dosagem , Estradiol/sangue , Feminino , Hormônio Foliculoestimulante/sangue , Força da Mão/fisiologia , Humanos , Vértebras Lombares/diagnóstico por imagem , Hormônio Luteinizante/sangue , Linestrenol/administração & dosagem , Masculino , Progestinas/sangue , Globulina de Ligação a Hormônio Sexual/metabolismo , Testosterona/sangue , Transexualidade/sangue , Transexualidade/diagnóstico por imagem , Resultado do TratamentoRESUMO
Background: The impact of testosterone (T) treatment on antidoping detection tests in female-to-male (F2M) transgender men is unknown. We investigated urine and serum sex steroid and luteinizing hormone (LH) profiles in T-treated F2M men to determine whether and, if so, how they differed from hypogonadal and healthy control men. Method: Healthy transgender (n = 23) and hypogonadal (n = 24) men aged 18 to 50 years treated with 1000 mg injectable T undecanoate provided trough urine and blood samples and an additional earlier postinjection sample (n = 21). Healthy control men (n = 20) provided a single blood and urine sample. Steroids were measured by mass spectrometry-based methods in urine and serum, LH by immunoassay, and uridine 5'-diphospho-glucuronosyltransferase 2B17 genotype by polymerase chain reaction. Results: Urine LH, human chorionic gonadotropin, T, epitestosterone (EpiT), androsterone (A), etiocholanolone (Etio), A/Etio ratio, dehydroepiandrosterone (DHEA), dihydrotestosterone (DHT), and 5α,3α- and 5ß,3α-androstanediols did not differ between groups or by time since last T injection. Urine T/EpiT ratio was <4 in all controls and 12/68 (18%) samples from T-treated men, but there was no difference between T-treated groups. Serum estradiol, estrone, and DHEA were higher in transgender men, and serum T and DHT were higher in earlier compared with trough blood samples, but serum LH, follicle-stimulating hormone, and 3α- and 3ß,5α-diols did not differ between groups. Conclusion: Urine antidoping detection tests in T-treated transgender men can be interpreted like those of T-treated hypogonadal men and are unaffected by time since last T dose. Serum steroids are more sensitive to detect exogenous T administration early but not later after the last T dose.
Assuntos
Androgênios/metabolismo , Estrogênios/metabolismo , Hipogonadismo/tratamento farmacológico , Testosterona/análogos & derivados , Transexualidade/tratamento farmacológico , Adolescente , Adulto , Androgênios/sangue , Androgênios/urina , Androsterona/sangue , Androsterona/urina , Desidroepiandrosterona/sangue , Desidroepiandrosterona/urina , Di-Hidrotestosterona/sangue , Di-Hidrotestosterona/urina , Estradiol/sangue , Estradiol/urina , Estrogênios/sangue , Estrogênios/urina , Estrona/sangue , Estrona/urina , Humanos , Hipogonadismo/sangue , Hipogonadismo/urina , Hormônio Luteinizante/sangue , Hormônio Luteinizante/urina , Masculino , Espectrometria de Massas , Pessoa de Meia-Idade , Testosterona/sangue , Testosterona/uso terapêutico , Testosterona/urina , Pessoas Transgênero , Transexualidade/sangue , Transexualidade/urina , Adulto JovemRESUMO
OBJECTIVE: Most transgender women depend on medical treatment alone to lower testosterone levels in order to align physical appearance with gender identity. The medical regimen in the United States typically includes spironolactone and estrogens. The purpose of this cross-sectional study was to assess the testosterone suppression achieved among transgender women treated with spironolactone and estrogens. METHODS: Testosterone and estradiol levels were extracted from the electronic medical records of 98 anonymized transgender women treated with oral spironolactone and oral estrogen therapy at the Endocrinology Clinic at Boston Medical Center. RESULTS: Patients starting therapy required about 9 months to reach a steady-state testosterone, with significant heterogeneity of levels achieved among patients. Patients with normal body mass index (BMI) had higher testosterone levels, whereas patients with obese BMI had lower testosterone levels throughout treatment. Stratification of patients by age or spironolactone dosage revealed no significant difference in testosterone levels achieved. At steady state, patients in the highest suppressing quartile were able to achieve testosterone levels of 27 ng/dL, with a standard deviation of 21 ng/dL. Measured serum estradiol levels did not change over time and did not correlate with dosage of estradiol administered. CONCLUSION: Among a cohort of transgender women treated with spironolactone and estrogen, the highest suppressing quartile could reliably achieve testosterone levels in the female range at virtually all times. The second highest suppressing quartile could not achieve female levels but remained below the male range virtually all of the time. One quartile was unable to achieve any significant suppression. ABBREVIATIONS: BMC = Boston Medical Center BMI = body mass index CPY = cyproterone acetate LC-MS/MS = liquid chromatography-tandem mass spectrometry Q = quartile.
Assuntos
Estrogênios/uso terapêutico , Procedimentos de Readequação Sexual , Espironolactona/uso terapêutico , Testosterona/sangue , Transexualidade/sangue , Transexualidade/terapia , Adulto , Idoso , Estudos Transversais , Acetato de Ciproterona/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos de Readequação Sexual/métodos , Pessoas Transgênero , Estados Unidos , Adulto JovemRESUMO
INTRODUCTION:: Transsexualism (ICD-10) is a condition characterized by a strong and persistent dissociation with one's assigned gender. Sex reassignment surgery (SRS) and hormone therapy provide a means of allowing transsexual individuals to feel more congruent with their gender and have played a major role in treatment over the past 70 years. Brain-derived neurotrophic factor (BDNF) appears to play a key role in recovery from acute surgical trauma and environmentally mediated vulnerability to psychopathology. We hypothesize that BDNF may be a biomarker of alleviation of gender incongruence suffering. OBJECTIVES:: To measure preoperative and postoperative serum BDNF levels in transsexual individuals as a biomarker of alleviation of stress related to gender incongruence after SRS. METHODS:: Thirty-two male-to-female transsexual people who underwent both surgery and hormonal treatment were selected from our initial sample. BDNF serum levels were assessed before and after SRS with sandwich enzyme linked immunosorbent assay (ELISA). The time elapsed between the pre-SRS and post-SRS blood collections was also measured. RESULTS:: No significant difference was found in pre-SRS or post-SRS BDNF levels or with relation to the time elapsed after SRS when BDNF levels were measured. CONCLUSION:: Alleviation of the suffering related to gender incongruence after SRS cannot be assessed by BDNF alone. Surgical solutions may not provide a quick fix for psychological distress associated with transsexualism and SRS may serve as one step toward, rather than as the conclusion of, construction of a person's gender identity.
Assuntos
Fator Neurotrófico Derivado do Encéfalo/sangue , Disforia de Gênero/sangue , Cirurgia de Readequação Sexual , Estresse Psicológico/sangue , Transexualidade/sangue , Adulto , Biomarcadores/sangue , Análise Química do Sangue , Ensaio de Imunoadsorção Enzimática , Feminino , Disforia de Gênero/tratamento farmacológico , Disforia de Gênero/psicologia , Disforia de Gênero/cirurgia , Infecções por HIV/sangue , Infecções por HIV/complicações , Terapia de Reposição Hormonal , Humanos , Masculino , Período Pós-Operatório , Período Pré-Operatório , Estudos Prospectivos , Estresse Psicológico/etiologia , Pessoas Transgênero/psicologia , Transexualidade/tratamento farmacológico , Transexualidade/psicologia , Transexualidade/cirurgia , Resultado do TratamentoRESUMO
PURPOSE OF REVIEW: To explore the medical and surgical clinical dilemmas in the management of trans (transgender) men, a growing population receiving more attention than in the past. RECENT FINDINGS: Testosterone therapy is commonly prescribed to trans men for masculinization. Nonetheless, the optimal formulations and doses of testosterone therapy for trans men have not been well established. Testosterone therapy has been associated with increased levels of hemoglobin and triglycerides, as well as diabetes. Periodic monitoring of hemoglobin, cholesterol, and fasting glucose is therefore recommended. As compared to non-transgender women, trans men have lower age-specific rates of breast cancer and cervical cancer which can be attributed, in part, to surgeries such as bilateral mastectomies and hysterectomies. The frequency in which to recommend mammograms and Pap smears (in patients with intact cervices) is uncertain in this population because of a lack of evidence-based data. Many trans men desire and undergo bilateral mastectomies with much fewer undergoing metoidioplasty or phalloplasty. SUMMARY: For trans men, most clinicians target serum testosterone concentrations in the normal male reference range. The frequency of screening for breast and cervical cancer should be individualized based upon anatomy, patient age, age of initiation of testosterone therapy, and other factors.
Assuntos
Pessoas Transgênero , Transexualidade/terapia , Diabetes Mellitus Tipo 2/etiologia , Feminino , Hemoglobinas/metabolismo , Humanos , Transtornos do Metabolismo dos Lipídeos/etiologia , Masculino , Fatores de Risco , Testosterona/sangue , Testosterona/uso terapêutico , Transexualidade/sangue , Transexualidade/complicações , Triglicerídeos/sangueRESUMO
Abstract Introduction: Transsexualism (ICD-10) is a condition characterized by a strong and persistent dissociation with one's assigned gender. Sex reassignment surgery (SRS) and hormone therapy provide a means of allowing transsexual individuals to feel more congruent with their gender and have played a major role in treatment over the past 70 years. Brain-derived neurotrophic factor (BDNF) appears to play a key role in recovery from acute surgical trauma and environmentally mediated vulnerability to psychopathology. We hypothesize that BDNF may be a biomarker of alleviation of gender incongruence suffering. Objectives: To measure preoperative and postoperative serum BDNF levels in transsexual individuals as a biomarker of alleviation of stress related to gender incongruence after SRS. Methods: Thirty-two male-to-female transsexual people who underwent both surgery and hormonal treatment were selected from our initial sample. BDNF serum levels were assessed before and after SRS with sandwich enzyme linked immunosorbent assay (ELISA). The time elapsed between the pre-SRS and post-SRS blood collections was also measured. Results: No significant difference was found in pre-SRS or post-SRS BDNF levels or with relation to the time elapsed after SRS when BDNF levels were measured. Conclusion: Alleviation of the suffering related to gender incongruence after SRS cannot be assessed by BDNF alone. Surgical solutions may not provide a quick fix for psychological distress associated with transsexualism and SRS may serve as one step toward, rather than as the conclusion of, construction of a person's gender identity.
Resumo Introdução: O transexualismo (CID-10) é uma condição caracterizada por forte e persistente dissociação com o gênero atribuído. A cirurgia de redesignação sexual (CRS) e a terapia hormonal (TH) permitem que indivíduos transexuais se sintam mais congruentes com seu gênero e, por isso, têm desempenhado papel importante nos últimos 70 anos. O fator neurotrófico derivado do cérebro (BDNF) parece desempenhar um papel fundamental na recuperação do trauma cirúrgico agudo e vulnerabilidade ambiental à psicopatologia. Nós hipotetizamos que o BDNF pode ser um biomarcador de alívio do sofrimento de incongruência de gênero pós-CRS. Objetivos: Mensurar os níveis séricos de BDNF no pré e pós-operatório em indivíduos transexuais como biomarcador de alívio de estresse relacionado à incongruência de gênero após a CRS. Métodos: Trinta e duas pessoas transexuais masculino para feminino submetidas a cirurgia e tratamento hormonal foram selecionadas de nossa amostra inicial. O nível sérico de BDNF foi avaliado antes e depois da CRS pela técnica ELISA. O tempo decorrido entre as coletas de sangue pré e pós-CRS foi medido. Resultados: Não houve diferença significativa nos níveis de BDNF pré e pós-CRS ou em relação ao tempo decorrido entre a CRS e a coleta. Conclusão: O alívio do sofrimento relacionado à incongruência de gênero pós-CRS não pode ser avaliado apenas pelo BDNF. Soluções cirúrgicas podem não fornecer uma solução rápida para o sofrimento associado ao transexualismo, e a CRS pode servir como um passo em direção à, em vez de conclusão da, construção da identidade de gênero de uma pessoa.
Assuntos
Humanos , Masculino , Feminino , Adulto , Estresse Psicológico/sangue , Transexualidade/sangue , Fator Neurotrófico Derivado do Encéfalo/sangue , Cirurgia de Readequação Sexual , Disforia de Gênero/sangue , Período Pós-Operatório , Transexualidade/cirurgia , Transexualidade/psicologia , Transexualidade/tratamento farmacológico , Análise Química do Sangue , Ensaio de Imunoadsorção Enzimática , Biomarcadores/sangue , Infecções por HIV/complicações , Infecções por HIV/sangue , Estudos Prospectivos , Resultado do Tratamento , Terapia de Reposição Hormonal , Período Pré-Operatório , Disforia de Gênero/cirurgia , Disforia de Gênero/psicologia , Disforia de Gênero/tratamento farmacológicoRESUMO
The cause of prolactin alterations in transgender persons is often assigned to oestrogens, but the precise cause and time course during different phases of cross-sex hormone treatment (CHT) remain unclear. In this study, we prospectively examined prolactin levels in 55 female-to-males (FtMs) and 61 male-to-females (MtFs) during the first year of CHT. Because long-term prolactin data were not available in this population, we studied these levels in a retrospective population of 25 FtMs and 38 MtFs who underwent gonadectomy. FtMs were treated with testosterone and MtFs with estradiol, with or without the anti-androgen cyproterone acetate (CPA) (after gonadectomy CPA is cessated). During the first year of CHT, prolactin decreased with 25% (95CI: -33%, -12%) in FtMs and increased with 193% (95CI: 156%, 219%) in MtFs. Eighteen MtFs developed hyperprolactinemia (≥0.6 IU L-1 ). In the retrospective population, post-gonadectomy levels in FtMs were lower than baseline levels (-39%; 95CI: -51%, -20%) while in MtFs post-gonadectomy levels and baseline levels were comparable (-6%; 95CI: -24%, 15%). No hyperprolactinemia was found after gonadectomy. In conclusion, in FtMs, prolactin decreased consistently during CHT and in MtFs, prolactin increased during pre-surgical CHT but normalised after gonadectomy. It is likely that CPA induces increasing prolactin levels in MtFs.
Assuntos
Antagonistas de Androgênios/uso terapêutico , Acetato de Ciproterona/uso terapêutico , Estrogênios/uso terapêutico , Prolactina/sangue , Testosterona/uso terapêutico , Transexualidade/sangue , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Pessoas Transgênero , Transexualidade/tratamento farmacológico , Resultado do Tratamento , Adulto JovemRESUMO
PURPOSE: The purpose of this study was to evaluate the brain activation pattern associated with sexual orientation and its correlation with the level of the free testosterone (free T) in postoperative female-to-male (FtM) transsexuals using a 3.0-Tesla functional magnetic resonance imaging (fMRI). MATERIALS AND METHODS: Eleven postoperative FtM transsexuals with sex reassignment surgery underwent fMRI on a 3.0-T MR scanner. Brain activity was measured while viewing erotic male and female nude pictures. RESULTS: The average level of free T in the FtM transsexuals was in the normal range of heterosexual men. The brain areas with predominant activities during viewing female nude pictures in contrast to male pictures included the hippocampus, parahippocampal gyrus, anterior cingulate gyrus, putamen, amygdala, hypothalamus, and insula (p < 0.005). The free T levels were positively correlated with the BOLD signal changes in the parahippocampal gyrus (Spearman's rho = 0.91, p < 0.001), hippocampus (rho = 0.90, p < 0.001), insula (rho = 0.68, p < 0.05), putamen (rho = 0.66, p < 0.05), and amygdala (rho = 0.64, p < 0.05). Compared to FtM transsexuals with deficient level of free T, the FtM transsexuals with normal range of free T showed significantly higher activities in the parahippocampal gyrus, hippocampus, insula, putamen, and amygdala during viewing female nude pictures (p < 0.005). CONCLUSION: This study revealed the specific brain activation pattern associated with sexual orientation and its correlation with free T in the postoperative FtM transsexuals. These findings are applicable in understanding the neural mechanism on sexual arousal in FtM transsexuals and their sexual orientation in connection with the free T levels.
Assuntos
Encéfalo/fisiologia , Cirurgia de Readequação Sexual , Testosterona/sangue , Pessoas Transgênero/psicologia , Transexualidade/psicologia , Adulto , Encéfalo/diagnóstico por imagem , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Transexualidade/sangueRESUMO
Although the prevailing opinion is that emotional processes are influenced by sex hormones, the literature is still inconclusive. The aim of the current study was to examine the effects of gonadal suppression on brain activity during affective picture processing. Twenty-one female-to-male (FtM) transsexuals and 19 control women were recruited and underwent functional magnetic resonance imaging scanning while rating emotional pictures adapted from the International Affective Picture System. The gonadal hormone production of the FtMs was suppressed for 8 weeks, the control group did not receive any treatment before scanning. Under gonadal suppression, FtMs showed less brain activation in the superior temporal lobe compared with female controls during perception of positive affective pictures. Regression analysis showed that during processing of positive affective images, brain activity within the right superior temporal lobe was not correlated with levels of estradiol, luteinizing hormone, and follicle-stimulating hormone. In the absence of associations with hormonal levels, the difference in activation in the superior temporal lobe during positive emotional stimuli between FtMs and control women may be attributed to a priori differences between the 2 groups. Future studies should clarify if these differences are a result of atypical sexual differentiation of the brain in FtMs.
Assuntos
Mapeamento Encefálico , Encéfalo/fisiopatologia , Emoções/fisiologia , Hormônios Esteroides Gonadais/sangue , Transexualidade/patologia , Adolescente , Adulto , Encéfalo/irrigação sanguínea , Estradiol , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Imageamento por Ressonância Magnética , Masculino , Testes Neuropsicológicos , Oxigênio/sangue , Estimulação Luminosa , Escalas de Graduação Psiquiátrica , Radioimunoensaio , Tempo de Reação/fisiologia , Transexualidade/sangue , Transexualidade/psicologia , Adulto JovemRESUMO
Several studies seem to support the hypothesis that brain anatomy is associated with transsexualism. However, these studies were still limited because few neuroanatomical findings have been obtained from female-to-male (FtM) transsexuals. This study compared the cerebral regional volumes of gray matter (GM) between FtM transsexuals and female controls using a voxel-based morphometry. Twelve FtM transsexuals who had undergone sex-reassignment surgery and 15 female controls participated in this study. Both groups were age matched and right-handed, with no history of neurological illness. Fifteen female controls were recruited to determine whether GM volumes in FtM transsexuals more closely resembled individuals who shared their biological sex. MRI data were processed using SPM 8 with the diffeomorphic anatomical registration through exponentiated Lie algebra (DARTEL). FtM transsexuals showed significantly larger volumes of the thalamus, hypothalamus, midbrain, gyrus rectus, head of caudate nucleus, precentral gyrus, and subcallosal area compared with the female controls. However, the female controls showed a significantly larger volume in the superior temporal gyrus including Heschl's gyrus and Rolandic operculum. These findings confirm that the volume difference in brain substructures in FtM transsexuals is likely to be associated with transsexualism and that transsexualism is probably associated with distinct cerebral structures, determining gender identity.
Assuntos
Encéfalo/patologia , Substância Cinzenta/patologia , Transexualidade/patologia , Córtex Cerebral/patologia , Feminino , Hormônios Esteroides Gonadais/sangue , Humanos , Imageamento por Ressonância Magnética , Masculino , Transexualidade/sangueRESUMO
BACKGROUND: Transpeople often look for sex reassignment surgery (SRS) to improve their quality of life (QoL). The hormonal therapy has many positive effects before and after SRS. There are no studies about correlation between hormonal status and QoL after SRS. AIM: To gather information on QoL, quality of sexual life and body image in transpeople at least 2 years after SRS,to compare these results with a control group and to evaluate the relations between the chosen items and hormonal status. SUBJECTS AND METHODS: Data from 60 transsexuals and from 60 healthy matched controls were collected. Testosterone,estradiol, LH and World Health Organization Quality of Life (WHOQOL-100) self-reported questionnaire were evaluated. Student's t test was applied to compare transsexuals and controls. Multiple regression model was applied to evaluate WHOQOL's chosen items and LH. RESULTS: The QoL and the quality of body image scores intranspeople were not statistically different from the matched control groups' ones. In the sexual life subscale,transwomen's scores were similar to biological women's ones, whereas transmen's scores were statistically lower than biological men's ones (P = 0.003). The quality of sexual life scored statistically lower in transmen than intranswomen (P = 0.048). A significant inverse relationship between LH and body image and between LH and quality of sexual life was found. CONCLUSIONS: This study highlights general satisfaction after SRS. In particular, transpeople's QoL turns out to be similar to Italian matched controls. LH resulted inversely correlated to body image and sexual life scores.
Assuntos
Imagem Corporal/psicologia , Estradiol/sangue , Hormônio Luteinizante/sangue , Qualidade de Vida/psicologia , Cirurgia de Readequação Sexual , Testosterona/sangue , Transexualidade , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Comportamento Sexual/psicologia , Transexualidade/sangue , Transexualidade/psicologia , Transexualidade/cirurgiaRESUMO
OBJECTIVE: To investigate the effect of hormonal androgenic treatment on antimüllerian hormone (AMH) serum levels in female-to-male (FtM) transsexuals. Polycystic ovary syndrome (PCOS) is associated with elevated AMH levels. Some hypothesize that the high AMH level is a consequence of androgen-induced excessive development of small antral follicles. However, this role of androgens is not yet clear. DESIGN: Observational, prospective, cohort study. SETTING: Tertiary academic medical center. PATIENT(S): Twenty-two FtM transsexuals, healthy native females receiving cross-sex hormone therapy/androgenic treatment. INTERVENTION(S): Androgenic treatment with testosterone (T) and an aromatase inhibitor while endogenous hormone secretion was suppressed with the use of a GnRH agonist. MAIN OUTCOME MEASURE(S): Hormone concentrations were measured before and after androgenic treatment (administration of T and aromatase inhibitor). Measured hormones: AMH, inhibin B, T, androstenedione, DHEAS, E2, SHBG, LH, and FSH. RESULT(S): AMH concentrations were significantly lower after androgenic treatment (4.4 ± 4.4 µg/L vs. 1.4 ± 2.1 µg/L). Androgenic treatment resulted in a strong suppression of AMH secretion over a relative short period of 16 weeks. CONCLUSION(S): Our data underscore the likely important role of androgens in the dynamics of folliculogenesis. It challenges the idea that androgens induce high AMH levels, which is gaining more interest nowadays as an important particular PCOS feature. This strong decline furthermore indicates that AMH must be interpreted in the context of other reproductive endocrine conditions. CLINICAL TRIAL REGISTRATION NUMBER: NTR2493.