Department of Endocrinology, VU University Medical Center, Amsterdam, the Netherlands; and Leiden University Medical Center, Department of Psychiatry, Leiden, The Netherlands

Transsexuals receive cross-sex hormone treatment. Its short-term use appears reasonably safe. Little is known about its long-term use. This report offers some perspectives.

A university hospital serving as the national referral center for in the Netherlands (16 million people).

From the start of the gender clinic in 1975 up to 2006, 2236 male-to-female and 876 female-to-male transsexuals have received cross-sex hormone treatment. In principle subjects are followed-up lifelong.

Male-to-female transsexuals receive treatment with the anti-androgen cyproterone acetate 100mg/d +estrogens (earlier 100 microg ethinyl-estradiol, now 2-4 mg oral estradiol valerate/d or 100 microg transdermal estradiol/d). Female-to-male transsexuals receive parenteral testosterone esters 250 mg/2 weeks. After 18-36 months surgical sex reassignment including gonadectomy follows inducing a profound hypogonadal state.

Morbidity and mortality data; data assessing risks of osteoporosis and cardiovascular disease.

Mortality was not higher than in a comparison group.

With ethinyl-estradiol there was a 6-8% incidence of venous thrombosis, which is no longer the case with use of other types of estrogens. Continuous use of cross-sex hormones is required to prevent osteoporosis. Androgen deprivation + an estrogen milieu in male-to-female transsexuals has a larger deleterious effect on cardiovascular risk factors than inducing an androgenic milieu in female-to-male transsexuals, but there is so far no elevated cardiovascular morbidity / mortality. Low numbers of endocrine related cancers have been observed in male-to-female transsexuals.

Cross-sex hormone treatment of transsexuals seems acceptably safe over the short and medium term but solid clinical data are lacking.

Written by
Gooren LJ, Giltay EJ, Bunck MC.

Reference
J Clin Endocrinol Metab. 2007 Nov 6 [Epub ahead of print]

PubMed Abstract
PMID:17986639

UroToday.com Androgen Deficiency Section

Please log-in or register in order to submit comments.

Powered by AkoComment!