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.
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Prior, J.C., Vigna, Y.M. & Watson, D. Spironolactone with physiological female steroids for presurgical therapy of male-to-female transsexualism. Arch Sex Behav 18, 49–57 (1989). https://doi.org/10.1007/BF01579291
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DOI: https://doi.org/10.1007/BF01579291