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Archives of Sexual Behavior

, Volume 18, Issue 1, pp 49–57 | Cite as

Spironolactone with physiological female steroids for presurgical therapy of male-to-female transsexualism

  • Jerilynn C. Prior
  • Yvette M. Vigna
  • Diane Watson
Article

Abstract

The clinical and hormonal response to 12-month therapy with the antiandrogen, spironolactone, in conjunction with near-physiologic doses of female gonadal steroids in 50 transsexual males, is presented. An unselected referred series of 61 men with the psychiatric diagnosis of transsexualism was treated; 10 subjects who had received previous gonadal surgery and 1 man with Klinefelter's syndrome were excluded. Twenty-seven conventionally treated (CT; high-dose estrogen), age 34.4 ± 10.5 years, mean ± SD, and 23 untreated patients (SPS), age 30.7 ± 6.2 years, were studied. Following the initial visit, all 50 were begun on spironolactone and low-dose female hormone therapy. Despite high-dose estrogen treatment for more than 2 years, the mean testosterone (T) level for the CT group was not in the female range (169 ± 193 ng/dl; normal 20–80). Spironolactone, in doses of 200–600 mg/day, lowered T to the female range in both groups after 12 months (CT 87 ± 111 and SPS 49 ± 41 ng/dl). This was achieved in the CT group despite decreases in estrogen dose and discontinuation of parenteral therapy. SPS subjects experienced significant decreases in plasma T (642 ± 236 to 49 ± 41 ng/dl, p < 0.001). Systolic blood pressure dropped (128 ± 14 to 121 ± 14 mm Hg, p < 0.05). The clinical response, including decreased male pattern hair, breast development, feminization, and lack of erections was excellent in most subjects.

Key words

transsexualism antiandrogen estrogen progesterone spironolactone 

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References

  1. Bell, J. I., Bishop, M. C., and Britton, B. J. (1977). Haemoperitoneum in a transsexual.Lancet 2: 817.Google Scholar
  2. Benjamin, H. (1964). Clinical aspects of transsexualism in the male and female.Am. J. Psychother. 18: 458–469.Google Scholar
  3. Brantley, J. T., and Wise, T. N. (1985). Antiandrogenic treatment of a gender-dysphoric transvestite.J. Sex Marital Ther. 11: 109–112.Google Scholar
  4. Cooper, M. A. (1984). Hormone treatment clinic for transsexuals.Hawaii Med. J. 43: 142–146.Google Scholar
  5. Coronary Drug Project Research Group. (1973). The Coronary Drug Project. Findings leading to discontinuation of the 2.5 mg/day estrogen group.J. Am. Med. Assoc. 225: 652–657.Google Scholar
  6. Cumming, D. C., Yang, J. C., Rebar, J. C., Rebar, R. W., and Yen, S. C. (1982). Treatment of hirsutism with spironolactone.J. Am. Med. Assoc. 247: 1295–1298.Google Scholar
  7. de Marinis, M., and Arnett, E. N. (1978). Cerebrovascular occlusion in a transsexual man taking mestranol.Arch. Intern. Med. 138: 1732–1733.Google Scholar
  8. de Vries C. P., Gooren L. J. G., and van der Veen E. A. (1986). The effect of cyproterone acetate alone and in combination with ethinylestradiol on the hypothalamic pituitary adrenal axis, prolactin and GH release in male-to-female transsexuals.Horm. Metab. Res. 18: 203–205.Google Scholar
  9. Fortin, C. J.,et al., (1984). Myocardial infarction and severe thromboembolic complications: As seen in estrogen-dependent transsexual.Arch. Intern. Med. 144: 1082–1083.Google Scholar
  10. Futterweit, W. (1980). Endocrine management of transsexuals.NY State J. Med. 122: 1260–1264.Google Scholar
  11. Futterweit, W., Gabrilove, J. L., and Smith Jr., H., (1984). Testicular steroidogenic response to human chorionic gonadotropin of fifteen male transsexuals on chronic estrogen treatment.Metabolism 33: 936–942.Google Scholar
  12. Givens, J. R. (1985). Treatment of hirsutism with spironolactone.Fertil. Steril. 43: 841–843.Google Scholar
  13. Goh, H. H., Ratnam, S. S., and London, D. R. (1984). The feminization of gonadrotrophin responses in intact male transsexuals.Clin. Endocrin. 20: 591–596.Google Scholar
  14. Goodwin, W. E., and Cummings, R. H. (1984). Squamous metaplasia of the verumontaniem with obstruction due to hypertrophy: Longterm effects of estrogen on the prostate in an ageing male to female transsexual.J. Urol. 131: 553–554.Google Scholar
  15. Gordon, G. G., Southren, A. L., and Tochimoto, S. (1970). Effect of medroxyprogesteroine acetate (Provera) on the metabolism and biological activity of testosterone.J. Clin. Endocrinol. 30: 449–456.Google Scholar
  16. Hamberger, C. (1969). Endocrine treatment of male and female transsexualism. In Green, R., and Money, J. (eds.),Transsexualism and Sex Reassignment Johns Hopkins Press, Baltimore, pp. 291–304.Google Scholar
  17. Kuiper, A. C., Cohen-Ketternis, P. T., and Van der Reyt, F. (1985). Transsexuality in the Netherlands: Some medical and legal aspects.Med. Law 4: 373–378.Google Scholar
  18. Lehrman, K. L. (1976). Pulmonary embolism in a transsexual man taking diethylstilbestrol.J. Am. Med. Assoc. 235: 532–523.Google Scholar
  19. Messina, M., Manieri, C., Biffignandi, P., Massucchetti, C., Novi, R. F., and Molinathi, G. M. (1983). Antiandrogenic properties of spironolactone. Clinical trial in the management of female hirsutism.J. Endocrinol. Invest. 6: 23–27.Google Scholar
  20. Phillips, G. B., Castelli, W. P., Abbott, R. D., and McNamara, P. M. (1983). Association of hyperestrogenemia and coronary heart disease in men in the Framingham cohort.Am. J. Med. 74: 863–869.Google Scholar
  21. Shapiro, G., and Evron, S. (1980). A novel use of spironolactone: treatment of hirsutism.J. Clin. Endocrinol. Metab. 51: 429–432.Google Scholar
  22. Steiner, B. W. (1985). The management of patients with gender disorders. In Steiner, B. W. (ed.),Gender Dysphoria Plenum Press, New York.Google Scholar
  23. Veterans Administration Co-operative Urological Research Group. (1967). Treatment and survival of patients with cancer of the prostate.Surg. Gynecol. Obstet. 124: 1011–1017.Google Scholar
  24. Vician, L., Shupnik, M. A., and Gorski, R. (1979). Effects of estrogen on primary ovine pituitary cell cultures: Stimulation of prolactin secretion, synthesis, and preprolactin messenger ribonucleic acid activity.Endocrinology 104(3): 736–743.Google Scholar
  25. Whitaker, M. D., Prior, J. C., Scheithauer, B., Dolman, L., Durity, F., and Pudek, R. (1985). Gonadrophin-secreting pituitary tumour: Report and review.Clin. Endocrinol. 22: 43–48.Google Scholar

Copyright information

© Plenum Publishing Corporation 1989

Authors and Affiliations

  • Jerilynn C. Prior
    • 1
  • Yvette M. Vigna
    • 1
  • Diane Watson
    • 2
  1. 1.Department of Medicine (Endocrinology)University of British Columbia, and Vancouver General HospitalVancouverCanada
  2. 2.Department of PsychiatryUniversity of British Columbia and Vancouver General HospitalVancouverCanada

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