Francesca Armillotta

Effects of Testosterone Undecanoate Administered Alone or in Combination with Letrozole or Dutasteride in Female to Male Transsexuals

INTRODUCTION Testosterone undecanoate (TU) has potential as androgen therapy for ovariectomized female to male (FtM) transsexual subjects; however, the long-term physiologic effects of TU treatment, the significance of testosterone (T), and the T metabolites dihydrotestosterone (DHT) and estradiol (E) on specific outcome parameters are currently unknown. AIM The aim of this study was to investigate the long-term treatment of TU with regard to bone metabolism, body composition, and lipid profile in FtM subjects, and to evaluate the relationship between observed effects and circulating levels of T, E, and DHT. MAIN OUTCOME MEASURES Circulating follicle-stimulating hormone, luteinizing hormone, T, E, DHT, and lipid concentrations were measured, as well as bone metabolism, body composition, and insulin resistance. METHODS This was a 1-year, randomized treatment, open-label, uncontrolled safety study. Fifteen ovariectomized FtM subjects from an outpatient clinic were divided into three groups to receive TU 1,000 mg alone or in combination with oral administration of letrozole (L) 2.5 mg/die or dutasteride (D) 0.5 mg/die for a period of 54 weeks. RESULTS TU alone and TU + D treatments were successful in terms of hormone adjustment, did not result in any adverse effects, and were well-tolerated. Bone mineral density decreased by an average of 0.9 g/cm(2) in the TU + L group, and the addition of D resulted in a failure to gain lean mass. CONCLUSIONS This study confirmed that TU is a successful and safe treatment for FtM subjects. These data indicate that E has an important role in bone metabolism and that DHT may play a role in muscle metabolism.

Laparoscopic treatment of interstitial twin pregnancy.

OBJECTIVE To describe a conservative management by laparoscopy of an unusual interstitial twin pregnancy. DESIGN Case report. SETTING University hospital. PATIENT(S) A 27-year-old woman, pregnant at 6th week of amenorrhea with interstitial twin pregnancy. INTERVENTION(S) The woman was submitted to two- and three-dimensional transvaginal ultrasound and to diagnostic hysteroscopy. Subsequently, we performed a laparoscopic procedure: conical exeresis of the uterine cornu using a monopolar hook without involving the uterine cavity. MAIN OUTCOME MEASURE(S) Conservation of the uterus, fertility preservation. RESULT(S) Successful conservative treatment of interstitial twin pregnancy. CONCLUSION(S) Conservative laparoscopic surgery can be used successfully in hemodynamically stable patients with an interstitial pregnancy.

T09-O-02 The impairment of sexual function stresses menopausal less than premenopausal women

Objective Menopause requires psychological and physical adjustments, due to the occurring dramatic hormonal changes. Sexuality is one of the aspects that undergoes the most profound modifications. Preliminary data suggest that sometimes postmenopausal women do not regard sexual changes as being problematic often readjusting their life and relationship according to their new physical status. This underlines the evaluation of personal distress in the diagnosis of sexual dysfunction in particular in menopause. The aim of our study was to evaluate sexual function and the way women feel comparing postmenopausal and pre-menopausal women. Design and Method The Female Sexual Index Function (FSIF) and the Female Sexual Distress Scale (FSDS) were completed by 74 menopausal and 100 premenopausal women. Results Resultsare reported in postmenopausal versus premenopausal women as median + SD: • age: 56.0+4.2 versus 27.6+4.3 years; • FSFI total score: 20.2+3.5 versus 28.7+6.9 (p=0.000); • FSFI score • (p=0.000); • FSDS score >15 in women with FSFI >26.5: 17/51 • (33.3%) versus 16/24 (66.7%) (p=0.007); • sexual dysfunctional women 17/74 (23%) versus 16 /100 • (p= 0.25). Conclusions Although in menopause there is a higher incidence of potential sexual problems, personal distress caused by these problems is lower among menopausal as compared to premenopausal women. This data further supports the importance of incorporating personal distress evaluation in the diagnosis of sexual dysfunction.

OC23.03: Comparison of the diagnostic accuracy of expert transvaginal ultrasound and PET/CT in the evaluation of adnexal masses

Study design: We reviewed our database of patients treated for TTTS by laser coagulation between 2002 and 2007, in which fetal MCA-PSV values were available. Data was transformed to multiples of the median (MoM) based on reference ranges earlier determined in MCDA twins. Paired analysis was performed to compare values 24h before with 48h after laser. Fetuses with MCA-PSV > 1.5 MoM within 48h after laser were analyzed separately. Results: 118 fetuses had both measurements around laser. MCAPSV increased significantly after laser. Of the values of 214 fetuses available 48h after laser, 27 (12.6%) had MCA-PSV > 1.5 MoM. ExRecipients (20/109; 18.3%) had more often MCA-PSV > 1.5Mom than Ex-Donors (7/105; 6.7%). 7/18 (39.8%) Ex-Recipients but no Ex-Donors with elevated MCA-PSV had a co-twin with MCA-PSV < 0.8 MoM, consistent with a twin-anemia-polycythemia-sequence (TAPS). One of these had an intra-uterine transfusion while all the others resolved spontaneously within the next weeks. 17/20 (85%) Ex-Recipients and 6/7 (85.7%) Ex-Donors with MCA-PSV > 1.5 MoM subsequently survived, compared to 90/98 (91.8%) and 89/90 (98.9%) with normal values 48h after laser (non significant). Conclusion: There was an overall increase in MCA-PSV 48h after laser. MCA-PSV > 1.5 MoM was observed in 13% of fetuses but more frequent in Ex-Recipients. In almost 40% of these TAPS was diagnosed. Increasing MCA-PSV values in fetuses with TAPS required additional therapies in two cases. An intrauterine transfusion was performed in one case and a cord coagulation in the other case. Overall, outcome of fetuses with elevated PSV shortly after laser is favorable.

T04-O-05 High dose Testosterone (T) treatment has no adverse effects on the endometrium of Female to Male transsexuals (FtM)

Objects T patches have been approved in Europe for replacement therapy in surgical menopausal women with hypoactive sexual desire. Long-term safety of T administration in women is still unknown. No data exists on the effects of T on the endometrium. The aim of this study is to evaluate the effects of high T doses administered for at least one year on the endometrium. Methods Endometrial biopsies from 30 FtM treated with T (i.m. injection of 100 mg Testoviron Depot /10 days), 30 postmenopausal women (M) undergoing vaginal hysterectomy and 5 premenopausal women (PrM) undergoing hysteroscopy for infertility problems were collected. Endometrial proliferation was evaluated on the basis of histopathology and expression of the Ki-67. Both M and PrM women had not received hormonal treatment for at least one year. Results In FtM T and estradiol (E) levels were increased to above normal female levels (T= 4.2+3.4 ng/mL; E=57.5+39.4 pg/mL). At histological analysis, FTM and M had atrophic endometrium and PrM women had proliferative endometrium. The mean Ki-67 expression in the endometrium was similar in FtM and M (1.1+1.1% and 0.6+0.9%) while it was higher in PrM (42.6 + 17.1; vs. FtM and M p= Conclusions Our data suggests that long term, high dose T treatment does not stimulate endometrial proliferation in FtM subjects. Exogenous T administration appears to contrast proliferative effects of estrogens on endometrium.

T04-P-04 Effects of Testosterone Undecanoate (TU) administered alone or in combination with letrozole or dutasteride in Female to Male transsexuals (FtM)

Introduction The role of testosterone (T) and its metabolites, diidrotestosterone (DHT) and estradiol (E), on different physiological functions is not completely known. Ovariectomized FtM T treated represent an interesting model to study the effects of T and its metabolites on different physiological functions. In this study, TU 1000 mg (Nebido ® ) was injected in 15 FtM (week 0, 6,18, 30 and 42) alone (n=5; group A) or in combination with dutasteride 5 mg/d (n=5; group B) or letrozole 5 mg/d (n=5; group C). Results Hormone, bone and metabolic parameters at baseline and at week 54 were: TotalT (nmol/L) GROUP A 7.9±6.0, 13.6±2.6, GROUP B 7.1±6.3, 18.4±4.6§, GROUP C 4.8±4.8, 18.2±4.2§, baseline and wk 54 respectively. E (pmol/L) GROUP A 64.4±43.4, 89.6±36.3, GROUP B 41.4±19.4, 76.0±47.4, GROUP C 37.8±23.1, 18.0±0.0* baseline and wk 54 respectively. DHT (nmol/L) GROUP A 1.3±1.2, 2.2±0.9, GROUP B 1.0±0.7, 0.4±0.1*, GROUP C 0.9±0.7, 2.7±1.3 baseline and wk 54 respectively. *= P §= P No significant changes of any parameters occurred except for bone mass density that significantly decreased in group C and lean mass that increased significantly less in group B as compared to group A. TU injections were well tolerated by all subjects. Conclusions This data suggests that TU is an optimal formulation for replacement in FtM that is well accepted and does not cause major problems. The aromatization of TU is important for maintenance of bone density while DHT may have a role in muscle mass maintenance.

OC26: The role of PET/CT in evaluation of sonographically difficult adnexal masses

Objectives: To describe the clinical and sonographic features of abdominal wall endometriotic nodules. Methods: Fifteen women (mean age 36 (range, 30–48)) years, with pathologically proven endometriosis of the abdominal wall were retrospectively recruited during the period between 2001 and 2007. Indications for ultrasound examination were: pain (10 cases, 67%), a palpable mass (seven cases, 47%) and suspicion of umbilical hernia (four cases, 27%). Results: In four cases (27%) the nodule was located on the scar of a previous Cesarean section while in nine (60%) cases it was located at the level of the umbilicus; of these, six patients had a history of laparoscopic surgery for endometriosis. In two women (13%) the nodule was found in the right inguinal canal. Five patients (33%) were asymptomatic, while in 10 cases (67%) cyclic or continuous spontaneous pain was reported. Associated symptoms suggestive of endometriosis were found: dysmenorrhoea in eight (53%) patients, dyspareunia in four (27%) and infertility in five (33%). Sonographically, in all patients the endometriotic nodules appeared as solid hypoechoic masses. Content was inhomogeneous in nine (60%) women; in all cases ill defined margins were found. Pressure exerted with the sonographic probe above the nodule gave pain and helped in the localization. Mean lesion diameter was 20 (± 12) mm. The nodule was located above the abdominal wall fascia muscularis in eight cases (53%), below the fascia in two (13%) while in five cases the nodule extended grossly through it. Doppler examination was performed in eight patients: in all cases scarce vascularization of the nodule was found. Conclusions: Hypoechoic nodules of the abdominal wall circumscribed by a hyperechoic rim should raise the suspicion of abdominal wall endometriosis even in patients with no history of endometriosis nor previous laparotomy or laparoscopic surgery. Pushing against the nodule with the ultrasound probe can strengthen such diagnostic suspicion thanks to the pain induced.

Androgens and male contraception

Purpose of reviewAt present, family planning still caters for a predominantly female clientele. The major reason for that is the shortcoming of currently available male contraceptives. Most recent clinical trials demonstrate that hormonal contraception may be feasible for men too. This chapter will discuss the efforts performed over the past decades to develop a male hormonal contraceptive analogous to the hormonal methods so successful in women, focusing in particular on the developments carried out in the last few years. Recent findingsLong-acting androgen–progestin regimens seem to be the best available choice to induce profound and reversible suppression of spermatogenesis in Caucasian men. Although more sensitive to the steroid suppressive effects on spermatogenesis, Chinese men may also benefit by the addition of a progestin to testosterone to obtain a regimen that provides optimal contraceptive protection. Larger efficacy studies are warranted to prove the efficacy and safety of these regimens. Recent surveys suggest that potential acceptability of new male hormonal contraceptives is high among both men and women. SummaryRecent studies have demonstrated that androgen–progestin regimens may represent optimal regimens for contraception in men. Effectiveness and safety of these regimens will have to be proved in large-scale, long-term trials that are currently being planned.