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The Female-to-Male Medical Treatment

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Management of Gender Dysphoria
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Abstract

Transsexualism refers to a condition where an individual identifies with a gender that differs from the assigned sex. Transsexual subjects may suffer from gender dysphoria, which is the distress caused by the feeling of being born to the wrong biologic sex. Gender dysphoria is undoubtedly a complex and multifaceted problem that requires a multidisciplinary approach for its diagnosis and treatment. It goes without saying that the goal of the therapy is to harmonize physical appearance with gender identity. In order to do so, treatments need to be customized, as some individuals need cross-sex hormone therapy and surgery to alleviate their gender dysphoria, others need only one of these treatment options, and some need neither.

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References

  1. Knudson G, De Cuypere G, Bockting W (2010) Process toward consensus on recommendations for revision of the DSM diagnoses of gender identity disorders by the World Professional Association for Transgender Health. Int J Transgenderism 12(2):54–59

    Article  Google Scholar 

  2. Coleman E, Bockting W, Botzer M, Cohen-Kettenis P, DeCuypere G et al (2011) Standards of care for the health of transsexual, transgender and gender-nonconforming people, Version 7. Int J Transgenderism 13:165–232

    Article  Google Scholar 

  3. Hembree WC, Cohen-Kettenis P, de Delemarre-van Waal HA, Gooren LJ, Meyer WJ 3rd et al (2009) Endocrine treatment of transsexual persons: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 94(9):3132–3154

    Article  CAS  PubMed  Google Scholar 

  4. Meyer WJ III, Bockting W, Cohen-Kettenis P et al (2001) The Harry Benjamin International Gender Dysphoria Association’s standards of care for gender identity disorders, 6th version. Int J Transgenderism 5:1–22. Available from http://www.wpath.org/Documents2/socv6.pdf

  5. Gooren LJ (2011) Care of transsexual persons. N Engl J Med 364(13):1251–1257

    Article  CAS  PubMed  Google Scholar 

  6. Godano A, Maggi M, Jannini E, Meriggiola MC, Ghigo E, Todarello O, Lenzi A, Manieri C (2009) SIAMS-ONIG consensus on hormonal treatment in gender identity disorders. J Endocrinol Invest 32(10):857–864

    Article  CAS  PubMed  Google Scholar 

  7. Gooren LJ, Giltay EJ, Bunck MC (2008) Long-term treatment of transsexuals with cross-sex hormones: extensive personal experience. J Clin Endocrinol Metab 93(1):19–25

    Article  CAS  PubMed  Google Scholar 

  8. van Kesteren PJ, Asscheman H, Megens JA, Gooren LJ (1997) Mortality and morbidity in transsexual subjects treated with cross-sex hormones. Clin Endocrinol (Oxf) 47(3):337–342

    Article  Google Scholar 

  9. Wierckx K, Mueller S, Weyers S, Van Caenegem E, Roef G et al (2012) Long-term evaluation of cross-sex hormone treatment in transsexual persons. J Sex Med 9:2641–2651

    Article  CAS  PubMed  Google Scholar 

  10. Tangpricha V, Ducharme SH, Barber TW, Chipkin SR (2003) Endocrinologic treatment of gender identity disorders. Endocr Pract 9(1):12–21

    Article  PubMed  Google Scholar 

  11. Wylie KR, Fung R Jr, Boshier C, Rotchell M (2009) Recommendations of endocrine treatment for patients with gender dysphoria. Sex Relationsh Ther 24(2):175–187

    Article  Google Scholar 

  12. Knezevich EL, Viereck LK, Drincic AT (2012) Medical management of adult transsexual persons. Pharmacotherapy 32(1):54–66

    Article  CAS  PubMed  Google Scholar 

  13. Beg S, Al-Khoury L, Cunningham GR (2008) Testosterone replacement in men. Curr Opin Endocrinol Diabetes Obes 15(4):364–370

    Article  CAS  PubMed  Google Scholar 

  14. Kalra S, Agrawal N, Kumar S, Sharma A (2010) Testosterone replacement in male hypogonadism. Clin Pharmacol 2:149–153

    PubMed Central  CAS  PubMed  Google Scholar 

  15. Harle L, Basaria S, Dobs AS (2005) Nebido: a long-acting injectable testosterone for the treatment of male hypogonadism. Expert Opin Pharmacother 6:1751–1759

    Article  CAS  PubMed  Google Scholar 

  16. Seftel A (2007) Testosterone replacement therapy for male hypogonadism: Part III. Pharmacologic and clinical profiles, monitoring, safety issues, and potential future agents. Int J Impot Res 19:2–24

    Article  CAS  PubMed  Google Scholar 

  17. Swerdloff RS, Wang C, Cunningham G, Dobs A, Iranmanesh A, Matsumoto AM et al (2000) Long-term pharmacokinetics of transdermal testosterone gel in hypogonadal men. J Clin Endocrinol Metab 85:4500–4510

    CAS  PubMed  Google Scholar 

  18. Bhowmick SK, Ricke T, Retting KR (2007) Sexual precocity in a 16-month-old boy induced by indirect topical exposure to testosterone. Clin Pediatr 46:540–543

    Article  Google Scholar 

  19. Bird DR, Vowles KD (1977) Liver damage from long-term methyl-testosterone. Lancet 2:400–401

    Article  CAS  PubMed  Google Scholar 

  20. Gooren L (2005) Hormone treatment of the adult transsexual patient. Horm Res 64(Suppl 2):31–36

    Article  CAS  PubMed  Google Scholar 

  21. Zitzmann M, Nieschlag E (2007) Androgen receptor gene CAG repeat length and body mass index modulate the safety and long-term intramuscular testosterone undecanoate therapy in hypogonadal men. J Clin Endocrinol Metab 92:3844–3853

    Article  CAS  PubMed  Google Scholar 

  22. Dahl M, Feldman JL, Goldberg JM, Jaberi A (2006) Physical aspects of transgender endocrine therapy. Int J Transgenderism 9:111–134

    Article  Google Scholar 

  23. Amirikia H, Savoy-Moore RT, Sundareson AS, Moghissi KF (1986) The effects of long-term androgen treatment on the ovary. Fertil Steril 45:202–208

    CAS  PubMed  Google Scholar 

  24. Futterweit W, Deligdish L (1986) Histopathological effects of exogenously administered testosterone in 19 female to male transsexuals. J Clin Endocrinol Metab 62:16–21

    Article  CAS  PubMed  Google Scholar 

  25. Gorin-Lazard A, Baumstarck K, Boyer L, Maquigneau A, Gebleux S et al (2012) Is hormonal therapy associated with better quality of life in transsexuals? A cross-sectional study. J Sex Med 9(2):531–541

    Article  PubMed  Google Scholar 

  26. Moore E, Wisniewski A, Dobs A (2003) Endocrine treatment of transsexual people: a review of treatment regimens, outcomes, and adverse effects. J Clin Endocrinol Metab 88(8):3467–3473

    Article  CAS  PubMed  Google Scholar 

  27. Choudhry R, Hodgins MB, Van der Kwast TH, Brinkmann AO, Boersma WJ (1992) Localisation of androgen receptor in human skin by immunohistochemistry: implications for the hormonal regulation of hair growth, sebaceous glands and sweat glands. J Endocrinol 133(3):467–475

    Article  CAS  PubMed  Google Scholar 

  28. Marynick SP, Chakmakjian ZH, McCaffree DL, Herndon JH Jr (1983) Androgen excess in cystic acne. N Engl J Med 308(17):981–986

    Article  CAS  PubMed  Google Scholar 

  29. Lai JJ, Chang P, Lai KP, Chen L, Chang C (2012) The role of androgen and androgen receptor in skin-related disorders. Arch Dermatol Res 304(7):499–510

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  30. Giltay EJ, Gooren LJ (2000) Effects of sex steroid deprivation/administration on hair growth and skin sebum production in transsexual males and females. J Clin Endocrinol Metab 85(8):2913–2921

    Article  CAS  PubMed  Google Scholar 

  31. Giltay EJ, Toorians AW, Sarabdjitsingh AR, De Vries NA, Gooren LJ (2004) Established risk factors for coronary heart disease are unrelated to androgen-induced baldness in female-to-male transsexuals. J Endocrinol 180(1):107–112

    Article  CAS  PubMed  Google Scholar 

  32. Gooren LJ, Giltay EJ (2008) Review of studies of androgen treatment of female-to-male transsexuals: effects and risks of administration of androgens to females. J Sex Med 5(4):765–776

    Article  CAS  PubMed  Google Scholar 

  33. Wierckx K, Elaut E, Van Caenegem E, Van De Peer F, Dedecker D et al (2011) Sexual desire in female-to-male transsexual persons: exploration of the role of testosterone administration. Eur J Endocrinol 165(2):331–337

    Article  CAS  PubMed  Google Scholar 

  34. Costantino A, Cerpolini S, Alvisi S (2013) A prospective study on sexual function and mood in female-to-male transsexuals during testosterone administration and after sex reassignment surgery. J Sex Marital Ther 39(4):321–335

    Article  PubMed  Google Scholar 

  35. Slagter MH, Gooren LJ, Scorilas A, Petraki CD, Diamandis EP (2006) Effects of long-term androgen administration on breast tissue of female-to-male transsexuals. J Histochem Cytochem 54(8):905–910

    Article  CAS  PubMed  Google Scholar 

  36. Baba T, Endo T, Honnma H, Kitajima Y, Hayashi T et al (2007) Association between polycystic ovary syndrome and female-to-female transsexuality. Hum Reprod 22(4):1011–1016

    Article  PubMed  Google Scholar 

  37. Grynberg M, Fanchin R, Dubost G, Colau JC, Bremont-Weil C et al (2010) Histology of genital tract and breast tissue after long-term testosterone administration in a female-to-male transsexual population. Reprod Biomed Online 20(4):553–558

    Article  CAS  PubMed  Google Scholar 

  38. Shi H, Seeley RJ, Clegg DJ (2009) Sexual differences in the control of energy homeostasis. Front Neuroendocrinol 30(3):396–404

    Article  CAS  PubMed  Google Scholar 

  39. Kotani K, Tokunaga K, Fujioka S, Kobatake T, Keno Y et al (1994) Sexual dimorphism of age-related changes in whole-body fat distribution in the obese. Int J Obes Relat Metab Disord 18(4):207–212

    CAS  PubMed  Google Scholar 

  40. Wajchenberg BL (2000) Subcutaneous and visceral adipose tissue: their relation to the metabolic syndrome. Endocr Rev 21(6):697–738

    Article  CAS  PubMed  Google Scholar 

  41. Elbers JM, Asscheman H, Seidell JC, Gooren LJ (1999) Effects of sex steroid hormones on regional fat depots as assessed by magnetic resonance imaging in transsexuals. Am J Pathol 276(2 Pt 1):E317–E325

    CAS  Google Scholar 

  42. Vigen R, O’Donnel CI, Baron A, Grunwald GK, Maddox TM et al (2013) Association of testosterone therapy with mortality, myocardial infarction, and stroke in men with low testosterone levels. JAMA 310(17):1829–1836

    Article  CAS  PubMed  Google Scholar 

  43. Elamin MB, Garcia MZ, Murad MH, Erwin PJ, Montori VM (2010) Effect of sex steroid use on cardiovascular risk in transsexual individuals: a systematic review and meta-analyses. Clin Endocrinol (Oxf) 72(1):1–10

    Article  CAS  Google Scholar 

  44. Tirabassi G, Gioia A, Giovannini L, Boscaro M, Corona G et al (2013) Testosterone and cardiovascular risk. Intern Emerg Med 8(Suppl 1):S65–S69

    Article  PubMed  Google Scholar 

  45. Jones TH, Arver S, Behre HM, Buvat J, Meuleman E et al; TIMES2 Investigators (2011) Testosterone replacement in hypogonadal men with type 2 diabetes and/or metabolic syndrome (the TIMES study). Diabetes Care 34(4):828–837

    Google Scholar 

  46. Jones TH, Saad F (2009) The effects of testosterone on risk factors for, and the mediators of, the atherosclerotic process. Atherosclerosis 207(2):318–327

    Article  CAS  PubMed  Google Scholar 

  47. Mathur A, Malkin C, Saeed B, Muthusamy R, Jones TH, Channer K (2009) Long-term benefits of testosterone replacement therapy on angina threshold and atheroma in men. Eur J Endocrinol 161(3):443–449

    Article  CAS  PubMed  Google Scholar 

  48. Giltay EJ, Hoogeveen EK, Elbers JM, Gooren LJ, Asscheman H, Stehouwer CD (1998) Effects of sex steroids on plasma total homocysteine levels: a study in transsexual males and females. J Clin Endocrinol Metab 83(2):550–553

    Article  CAS  PubMed  Google Scholar 

  49. Xu L, Freeman G, Cowling BJ, Schooling CM (2013) Testosterone therapy and cardiovascular events among men: a systematic review and meta-analysis of placebo-controlled randomized trials. BMC Med 11:108

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  50. Mueller A, Gooren L (2008) Hormone-related tumors in transsexuals receiving treatment with cross-sex hormones. Eur J Endocrinol 159(3):197–202

    Article  CAS  PubMed  Google Scholar 

  51. Shao T, Grossbard ML, Klein P (2011) Breast cancer in female-to male transsexuals: two cases with a review of physiology and management. Clin Breast Cancer 11(6):417–419

    Article  PubMed  Google Scholar 

  52. Key T, Appleby P, Barnes I, Reeves G, Endogenous hormones and breast cancer collaborative group (2002) Endogenous sex hormones and breast cancer in postmenopausal women: reanalysis of nine prospective studies. J Natl Cancer Inst 94(8):606–616

    Article  CAS  PubMed  Google Scholar 

  53. North American Menopause Society (2005) The role of testosterone therapy in postmenopausal women: position statement of The North American Menopause Society. Menopause 12(5):496–511

    Article  Google Scholar 

  54. Anderson KE, Sellers TA, Chen PL, Rich SS, Hong CP, Folsom AR (1997) Association of Stein-Leventhal syndrome with the incidence of postmenopausal breast carcinoma in a large prospective study of women in Iowa. Cancer 79(3):494–499

    Article  CAS  PubMed  Google Scholar 

  55. Balen A (2001) Polycystic ovary syndrome and cancer. Hum Reprod Update 7(6):522–525

    Article  CAS  PubMed  Google Scholar 

  56. Burcobe RJ, Makris A, Pittam M, Finer N (2003) Breast cancer after bilateral subcutaneous mastectomy in a female-to-male transsexuals. Breast 12(4):290–293

    Article  Google Scholar 

  57. Hage JJ, Dekker ML, Karim RB, Verheijen RHM, Bloemena E (2000) Ovarian cancer in female-to-male transsexuals: report of two cases. Gynecol Oncol 76(3):413–415

    Article  CAS  PubMed  Google Scholar 

  58. Dizon DS, Tejada-Berges T, Koelliker S, Steinhoff M, Granai OC (2006) Ovarian cancer associated with testosterone supplementation in a female-to-male transsexual patient. Gynecol Obstet Invest 62(4):226–228

    Article  PubMed  Google Scholar 

  59. Chadha S, Pache TD, Huikeshoven JM, Brinkmann AO, van der Kwast TH (1994) Androgen receptor expression in human ovarian and uterine tissue of long-term androgen-treated transsexual women. Hum Pathol 25(12):1198–1204

    Article  CAS  PubMed  Google Scholar 

  60. Hillier SG, Ross GT (1979) Effects of exogenous testosterone on ovarian weight, follicular morphology and intraovarian progesterone concentration in estrogen-primed hypophysectomized immature female rats. Biol Reprod 20(2):261–268

    Article  CAS  PubMed  Google Scholar 

  61. Futterweit W (1998) Endocrine therapy of transsexualism and potential complications of long-term treatment. Arch Sex Behav 27(2):209–2266

    Article  CAS  PubMed  Google Scholar 

  62. Lips P, van Kesteren PJ, Asscheman H, Gooren LJ (1996) The effect of androgen treatment on bone metabolism in female-to-male transsexuals. J Bone Miner Res 11(11):1769–1773

    Article  CAS  PubMed  Google Scholar 

  63. van Kesteren P, Lips P, Gooren LJ, Asscheman H, Megens J (1998) Long-term follow-up of bone mineral density and bone metabolism in transsexuals treated with cross-sex hormones. Clin Endocrinol (Oxf) 48(3):347–354

    Article  Google Scholar 

  64. Meriggiola MC, Jannini EA, Lenzi A, Maggi M, Manieri C (2010) Endocrine treatment of transsexual persons: an Endocrine Society Clinical Practice Guideline: commentary from a European perspective. Eur J Endocrinol 162(5):831–833

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Bruno Fabris .

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Fabris, B., Bernardi, S. (2015). The Female-to-Male Medical Treatment. In: Trombetta, C., Liguori, G., Bertolotto, M. (eds) Management of Gender Dysphoria. Springer, Milano. https://doi.org/10.1007/978-88-470-5696-1_26

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  • DOI: https://doi.org/10.1007/978-88-470-5696-1_26

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