In an effort to elucidate the aetiology of
female-to-male transsexualism (FM-TS) 12 out of an annual sample of 16
untreated female-to-male transsexuals (FMT), aged 19 years 7 months (19;7)
to 44 years 8 months (44;8) [median age (M) 27;5] were assessed by means of
sexual-medical questionnaires, physical and endocrinological examination.
The control group consisted of 15 healthy
women (CF), aged 19 years 2 months (19;2) to 36 years 1 month (36;1) (M
22;7) without gender identity disorder, who were not under hormonal
medication (including contraceptives). Baseline levels of testosterone (T;
ng/dl), androstenedione (A4; ng/dl), dehydroepiandrosterone sulfate (DHEAS;
ng/ml), luteinizing hormone (LH; IU/l), follicle stimulating hormone (FSH;
IU/l), and sex-hormone binding globuline (SHBG; microgram/dl) were measured.
A standard single-dose ACTH stimulation
test (250 micrograms ACTH IV; Synacthen) was performed with all subjects.
Aldosterone (ALDO), corticosterone (B), deoxycorticosterone (DOC),
progesterone (PROG), 17-hydroxyprogesterone (17OHP), 11-deoxycortisol (S),
cortisol (F), cortisone (E), pregnenolone (PREG) and 17-hydroxypregnenolone
(OHPREG) were assessed before and 60 min after ACTH stimulation.
Transvaginal ultrasound was performed in nine out of 12 FMT (20;11 to 44;8,
M 27;5; m 29.1 +/- 7.5) but not in CF.
Results showed that 10 FMT (83.3%) and five
CF (33.3%) were above normal values for at least one of the measured
androgens. Baseline levels of T and A4 were significantly higher in FMT than
in CF (T: 54.0 +/- 13.8 vs. 41.1 +/- 12.8; A4: 244.8 +/- 73.0 vs. 190.5 +/-
49.3; p < .05), whereas DHEAS, SHBG, LH and FSH did not differ between
the groups. Unbound T (T/SHBG ratio) was higher in FMT (72.0 +/- 67.6) than
in CF (26.4 +/- 15.1). Baseline levels of 17OHP, OHPREG and DOC were higher
in FMT than in CF (p < .05). After ACTH stimulation 17OHP and OHPREG
remained higher in FMT than in CF (p < .05). Single case analysis of ACTH
stimulation test together with physical examination revealed symptoms for
non-classical congenital adrenal hyperplasia (NC-CAH) in six FMT (50%) and
two CF (13.3%).
Eight out of nine FMT who were assessed by
means of transvaginal ultrasound (i.e. 88.9%; 50.0% of 16) had polycystic
ovaries (PCO). Oligomenorrhoea or menstrual dysregularities (81.7% of 16 FMT
vs. 0% of CF), hirsutism (56.2% of 16 FMT vs. 13.3% of 15 CF) and adiposity
(25.0% vs. 0%) were frequent in FMT, but not in CF.
Hyperandrogenism with polycystic ovarian
syndrome (PCOS) and adrenocortical hyperresponsiveness to ACTH seems to be a
common finding in FMT. This offers support for a hormonal factor in the
genesis of FM-TS. Because the prevalence of PCOS and NC-CAH in the female
population is higher than FM-TS, the true nature of this factor and its
interaction with environmental influences remains unknown.
Citation:
Psychoneuroendocrinology 1997 Jul;22(5):361-80 an article published on the
Internet by PubMed <http://www.ncbi.nlm.nih.gov/>
