Skip to main content
SpringerLink
Log in

Sympathovagal imbalance in transsexual subjects

  • Original Articles
  • Published:
Journal of Endocrinological Investigation Aims and scope Submit manuscript

Abstract

Context: Autonomic nervous system imbalance is related to cardiovascular risk. Heart rate variability (HRV) indexes are associated with age, race, and sex, but the role of sex hormones is still unknown. Objective: To evaluate sympathovagal balance (SB) in transsexuals. Patients: Eighteen transsexual subjects, 12 male-to-female (group 1) and 6 female-to-male (group 2), compared with 34 age-matched controls: 17 males (group 3) and 17 females (group 4). Autonomic testing of SB was performed by Power Spectral Analysis (PSA) of HRV in clinostatism (c) and orthostatism (o). PSA identifies power peaks: high frequency (HF) expresses vagal activity, while low frequency (LF) expresses sympathetic activity. Results: Group 1 showed lower LFc than groups 2, 3, and 4 (p<0.001, p=0.05, p<0.001, respectively), and lower LFo than groups 3 and 4 (p=0.01); HFc was lower than in groups 2, 3, and 4 (p=0.02, p=0.02, p<0.001, respectively), and HFo was lower than in groups 3 and 4 (p<0.001). LFo/HFo ratio was higher in group 1 than in group 4 (p<0.001). No differences emerged between groups 2 and 3. Group 2 showed lower HFo than group 4 (p=0.03), and a higher LFo/HFo ratio (p=0.01). Group 3 showed lower HFo and HFc than group 4 (p=0.02, p=0.05, respectively), and a higher LFo/HFo ratio (p=0.03). Conclusion: In this study we found a sympathovagal imbalance due to a reduced sympathetic and parasympathetic influence on heart rate. Sex hormone therapy per se may play a role in this imbalance, and HRV measurement could be useful in detecting cardiovascular risk in transsexuals.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Malliani A, Lombardi F, Pagani M, Cerutti S. Power spectral analysis of cardiovascular variability in patients at risk for sudden cardiac death. J Cardiovasc Electrophysiol 1994, 5: 274–86.

    Article  PubMed  CAS  Google Scholar 

  2. Vanoli E, Schwartz PJ. Sympathetic-parasympathetic interaction and sudden death. Basic Res Cardiol 1990, 85 (Suppl 1): 305–21.

    PubMed  Google Scholar 

  3. Lombardi F, Malliani A, Pagani M, Cerutti S. Heart rate variability and its sympatho-vagal modulation. Cardiovasc Res 1996, 32: 208–16.

    Article  PubMed  CAS  Google Scholar 

  4. Sosnowski M, Clark E, Latif S, Macfarlane PW, Tendera M. Heart rate variability fraction—a new reportable measure of 24 h R-R interval variation. Ann Noninvasive Elettrocardiol 2005, 10: 7–15.

    Article  Google Scholar 

  5. Malliani A. Heart rate variability: from bench to bedside. Eur J Intern Med 2005, 16: 12–20.

    Article  PubMed  Google Scholar 

  6. Heart rate variability. Guidelines. Standards of measurements, physiological interpretation and clinical use. Task Force of the European society of Cardiology and The North American Society of Pacing and Electrophysiology. Eur Heart J 1996, 17: 354–81.

    Article  Google Scholar 

  7. Kleiger RE, Stein PK, Bigger JT Jr. Heart rate variability: measurement and clinical utility. Ann Noninvasive Elettrocardiol 2005, 10: 88–101.

    Article  Google Scholar 

  8. Spallone V, Uccioli L, Menzinger G. Diabetic autonomic neuropathy. Diabetes Metab Rev 1995, 11: 227–57.

    Article  PubMed  CAS  Google Scholar 

  9. Aring AM, Jones DE, Falko JM. Evaluation and prevention of diabetic neuropathy. Am Fam Physician 2005, 71: 2123–8.

    PubMed  Google Scholar 

  10. Low PA, Benrud-Larson LM, Sletten DM, et al. Autonomic symptoms and diabetic neuropathy: a population-based study. Diabetes Care 2004, 27: 2942–7.

    Article  PubMed  Google Scholar 

  11. Resmini E, Casu M, Patrone V, et al. Sympathovagal imbalance in acromegalic patients. J Clin Endocrinol Metab 2006, 91: 115–20.

    Article  PubMed  CAS  Google Scholar 

  12. Evans JM, Ziegler MG, Patwardhan AR, et al. Gender differences in autonomic cardiovascular regulation: spectral, hormonal, and hemodynamic indexes. J Appl Physiol 2001, 91: 2611–8.

    PubMed  CAS  Google Scholar 

  13. Stein PK, Kleiger RE, Rottman JN. Differing effects of age on heart rate variability in men and women. Am J Cardiol 1997, 80: 302–5.

    Article  PubMed  CAS  Google Scholar 

  14. Bonnemeier H, Richardt G, Potratz J, et al. Circadian profile of cardiac autonomic nervous modulation in healthy subjects: differing effects of aging and gender on heart rate variability. J Cardiovasc Electrophysiol 2003, 14: 791–9.

    Article  PubMed  Google Scholar 

  15. Liu CC, Kuo TB, Yang CC. Effects of estrogen on gender-related autonomic differences in humans. Am J Physiol Heart Circ Physiol 2003,285: H2188–93.

    PubMed  CAS  Google Scholar 

  16. Rosano GM, Panina G. Oestrogens and the heart. Thérapie 1999, 54: 381–5.

    PubMed  CAS  Google Scholar 

  17. La Rovere MT, Bigger JT Jr, Marcus FI, Mortara A, Schwartz PJ. Baroreflex sensitivity and heart-rate variability in prediction of total cardiac mortality after myocardial infarction. ATRAMI (Autonomic Tone and Reflexes After Myocardial Infarction) Investigators. Lancet 1998, 351: 478–84.

    Article  PubMed  Google Scholar 

  18. Mortara A, La Rovere MT, Pinna GD, et al. Arterial baroreflex modulation of heart rate in chronic heart failure: clinical and hemodynamic correlates and prognostic implications Circulation 1997, 18: 3450–8.

    Article  Google Scholar 

  19. Bush TL, Barrett-Connor E, Cowan LD, et al. Cardiovascular mortality and noncontraceptive use of estrogen in women: results from the Lipid Research Clinics Program Follow-up Study. Circulation 1987,75: 1102–9.

    Article  PubMed  CAS  Google Scholar 

  20. Rossouw JE, Anderson GL, Prentice RL, et al; Writing Group for the Women’s Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results for the Women’s Health Initiative randomized controlled trial. JAMA 2002, 288: 321–33.

    Article  PubMed  CAS  Google Scholar 

  21. Elbers JM, Giltay EJ, Teerlink T, et al. Effects of sex steroids on components of the insulin resistance syndrome in transsexual subjects. Clin Endocrinol (Oxf) 2003, 58: 562–71.

    Article  CAS  Google Scholar 

  22. Malliani A, Pagani M, Lombardi F, Cerutti S. Cardiovascular neural regulation explored in the frequency domain. Circulation 1991, 84: 482–92.

    Article  PubMed  CAS  Google Scholar 

  23. Cowan MJ. Measurement of heart rate variability. West J Nurs Res 1995, 17: 32–48.

    Article  PubMed  CAS  Google Scholar 

  24. Singh JP, Larson MG, Tsuji H, Evans JC, O’Donnell CJ, Levy D. Reduced heart rate variability and new-onset hypertension: insights into pathogenesis of hypertension: the Framingham Heart Study. Hypertension 1998,32: 293–7.

    Article  PubMed  CAS  Google Scholar 

  25. Casolo GC, Stroder P, Signorini C, et al. Heart rate variability during the acute phase of myocardial infarction. Circulation 1992, 85: 2073–9.

    Article  PubMed  CAS  Google Scholar 

  26. Janszky I, Ericson M, Mittleman MA, et al. Heart rate variability in long-term risk assessment in middle-aged women with coronary heart disease: The Stockholm Female Coronary Risk Study. J Intern Med 2004, 255: 13–21.

    Article  PubMed  CAS  Google Scholar 

  27. Conte MR. Gender differences in the neurohumoral control of the cardiovascular system. Ital Heart J 2003, 4: 367–70.

    PubMed  Google Scholar 

  28. Matsukawa T, Sugiyama Y, Watanabe T, Kobayashi F, Mano T. Gender difference in age-related changes in muscle sympathetic nerve activity in healthy subjects. Am J Physiol 1998, 275: R1600–4.

    PubMed  CAS  Google Scholar 

  29. Evans JM, Ziegler MG, Patwardhan AR, et al. Gender differences in autonomic cardiovascular regulation: spectral, hormonal, and hemodynamic indexes. J Appl Physiol 2001, 91: 2611–8.

    PubMed  CAS  Google Scholar 

  30. Du XJ, Riemersma RA, Dart AM. Sex differences in the parasympathetic nerve control of rat heart. Clin Exp Pharmacol Physiol 1994, 21: 485–93.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Endocrinology and Medical Sciences and Center of Excellence for Biomedical Research, Italy

    E. Resmini MD, A. Rebora, F. Minuto & D. Ferone

  2. Division of Internal Medicine, San Martino University Hospital, Genoa, Italy

    M. Casu, V. Patrone & G. Murialdo

Authors
  1. E. Resmini MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Casu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. V. Patrone
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Rebora
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G. Murialdo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. F. Minuto
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. D. Ferone
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to E. Resmini MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Resmini, E., Casu, M., Patrone, V. et al. Sympathovagal imbalance in transsexual subjects. J Endocrinol Invest 31, 1014–1019 (2008). https://doi.org/10.1007/BF03345641

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03345641

Key Words

Search

Navigation