Long-term treatment of transsexuals with cross-sex hormones: extensive personal experience. Export

@article{citeulike:2216572, abstract = {CONTEXT: Transsexuals receive cross-sex hormone treatment. Its short-term use appears reasonably safe. Little is known about its long-term use. This report offers some perspectives. SETTING: The setting was a university hospital serving as the national referral center for The Netherlands (16 million people). PATIENTS: From the start of the gender clinic in 1975 up to 2006, 2236 male-to-female and 876 female-to-male transsexuals have received cross-sex hormone treatment. In principle, subjects are followed up lifelong. INTERVENTIONS: Male-to-female transsexuals receive treatment with the antiandrogen cyproterone acetate 100 mg/d plus estrogens (previously 100 microg ethinyl estradiol, now 2-4 mg oral estradiol valerate/d or 100 microg transdermal estradiol/d). Female-to-male transsexuals receive parenteral testosterone esters 250 mg/2 wk. After 18-36 months, surgical sex reassignment including gonadectomy follows, inducing a profound hypogonadal state. MAIN OUTCOME MEASURES: Outcome measures included morbidity and mortality data and data assessing risks of osteoporosis and cardiovascular disease. RESULTS: Mortality was not higher than in a comparison group. Regarding morbidity, with ethinyl estradiol, there was a 6-8\% incidence of venous thrombosis, which is no longer the case with use of other types of estrogens. Continuous use of cross-sex hormones is required to prevent osteoporosis. Androgen deprivation plus an estrogen milieu in male-to-female transsexuals has a larger deleterious effect on cardiovascular risk factors than inducing an androgenic milieu in female-to-male transsexuals, but there is so far no elevated cardiovascular morbidity/mortality. Low numbers of endocrine-related cancers have been observed in male-to-female transsexuals. CONCLUSIONS: Cross-sex hormone treatment of transsexuals seems acceptably safe over the short and medium term, but solid clinical data are lacking.}, author = {Gooren, L. J. and Giltay, E. J. and Bunck, M. C.}, citeulike-article-id = {2216572}, citeulike-linkout-0 = {http://dx.doi.org/10.1210/jc.2007-1809}, citeulike-linkout-1 = {http://jcem.endojournals.org/cgi/content/abstract/93/1/19}, citeulike-linkout-2 = {http://view.ncbi.nlm.nih.gov/pubmed/17986639}, citeulike-linkout-3 = {http://www.hubmed.org/display.cgi?uids=17986639}, day = {1}, doi = {10.1210/jc.2007-1809}, issn = {0021-972X}, journal = {The Journal of clinical endocrinology and metabolism}, month = {January}, number = {1}, pages = {19--25}, posted-at = {2009-10-21 13:38:30}, priority = {2}, title = {Long-term treatment of transsexuals with cross-sex hormones: extensive personal experience.}, url = {http://dx.doi.org/10.1210/jc.2007-1809}, volume = {93}, year = {2008} }

TY - JOUR ID - citeulike:2216572 L3 - citeulike-article-id:2216572 N2 - CONTEXT: Transsexuals receive cross-sex hormone treatment. Its short-term use appears reasonably safe. Little is known about its long-term use. This report offers some perspectives. SETTING: The setting was a university hospital serving as the national referral center for The Netherlands (16 million people). PATIENTS: From the start of the gender clinic in 1975 up to 2006, 2236 male-to-female and 876 female-to-male transsexuals have received cross-sex hormone treatment. In principle, subjects are followed up lifelong. INTERVENTIONS: Male-to-female transsexuals receive treatment with the antiandrogen cyproterone acetate 100 mg/d plus estrogens (previously 100 microg ethinyl estradiol, now 2-4 mg oral estradiol valerate/d or 100 microg transdermal estradiol/d). Female-to-male transsexuals receive parenteral testosterone esters 250 mg/2 wk. After 18-36 months, surgical sex reassignment including gonadectomy follows, inducing a profound hypogonadal state. MAIN OUTCOME MEASURES: Outcome measures included morbidity and mortality data and data assessing risks of osteoporosis and cardiovascular disease. RESULTS: Mortality was not higher than in a comparison group. Regarding morbidity, with ethinyl estradiol, there was a 6-8% incidence of venous thrombosis, which is no longer the case with use of other types of estrogens. Continuous use of cross-sex hormones is required to prevent osteoporosis. Androgen deprivation plus an estrogen milieu in male-to-female transsexuals has a larger deleterious effect on cardiovascular risk factors than inducing an androgenic milieu in female-to-male transsexuals, but there is so far no elevated cardiovascular morbidity/mortality. Low numbers of endocrine-related cancers have been observed in male-to-female transsexuals. CONCLUSIONS: Cross-sex hormone treatment of transsexuals seems acceptably safe over the short and medium term, but solid clinical data are lacking. IS - 1 JF - The Journal of clinical endocrinology and metabolism SN - 0021-972X EP - 25 TI - Long-term treatment of transsexuals with cross-sex hormones: extensive personal experience. VL - 93 SP - 19 AU - Gooren, LJ AU - Giltay, EJ AU - Bunck, MC PY - 2008/01/01/ UR - http://dx.doi.org/10.1210/jc.2007-1809 ER -