Reinhard Wille

A HIGHER RATE OF HYPERANDROGENIC DISORDERS IN FEMALE-TO-MALE TRANSSEXUALS

In an effort to elucidate the aetiology of female-to-male transsexualism (FM-TS) 12 out of an annual sample of 16 untreated female-to-male transsexuals (FMT), aged 19 years 7 months (19;7) to 44 years 8 months (44;8) [median age (M) 27;5] were assessed by means of sexual-medical questionnaires, physical and endocrinological examination. The control group consisted of 15 healthy women (CF), aged 19 years 2 months (19;2) to 36 years 1 month (36;1) (M 22;7) without gender identity disorder, who were not under hormonal medication (including contraceptives). Baseline levels of testosterone (T; ng/dl), androstenedione (A4; ng/dl), dehydroepiandrosterone sulfate (DHEAS; ng/ml), luteinizing hormone (LH; IU/l), follicle stimulating hormone (FSH; IU/l), and sex-hormone binding globuline (SHBG; microgram/dl) were measured. A standard single-dose ACTH stimulation test (250 micrograms ACTH IV; Synacthen) was performed with all subjects. Aldosterone (ALDO), corticosterone (B), deoxycorticosterone (DOC), progesterone (PROG), 17-hydroxyprogesterone (17OHP), 11-deoxycortisol (S), cortisol (F), cortisone (E), pregnenolone (PREG) and 17-hydroxypregnenolone (OHPREG) were assessed before and 60 min after ACTH stimulation. Transvaginal ultrasound was performed in nine out of 12 FMT (20;11 to 44;8, M 27;5; m 29.1 +/- 7.5) but not in CF. Results showed that 10 FMT (83.3%) and five CF (33.3%) were above normal values for at least one of the measured androgens. Baseline levels of T and A4 were significantly higher in FMT than in CF (T: 54.0 +/- 13.8 vs. 41.1 +/- 12.8; A4: 244.8 +/- 73.0 vs. 190.5 +/- 49.3; p < .05), whereas DHEAS, SHBG, LH and FSH did not differ between the groups. Unbound T (T/SHBG ratio) was higher in FMT (72.0 +/- 67.6) than in CF (26.4 +/- 15.1). Baseline levels of 17OHP, OHPREG and DOC were higher in FMT than in CF (p < .05). After ACTH stimulation 17OHP and OHPREG remained higher in FMT than in CF (p < .05). Single case analysis of ACTH stimulation test together with physical examination revealed symptoms for non-classical congenital adrenal hyperplasia (NC-CAH) in six FMT (50%) and two CF (13.3%). Eight out of nine FMT who were assessed by means of transvaginal ultrasound (i.e. 88.9%; 50.0% of 16) had polycystic ovaries (PCO). Oligomenorrhoea or menstrual dysregularities (81.7% of 16 FMT vs. 0% of CF), hirsutism (56.2% of 16 FMT vs. 13.3% of 15 CF) and adiposity (25.0% vs. 0%) were frequent in FMT, but not in CF. Hyperandrogenism with polycystic ovarian syndrome (PCOS) and adrenocortical hyperresponsiveness to ACTH seems to be a common finding in FMT. This offers support for a hormonal factor in the genesis of FM-TS. Because the prevalence of PCOS and NC-CAH in the female population is higher than FM-TS, the true nature of this factor and its interaction with environmental influences remains unknown.

Castration in Germany

The medical and legal application of castration, including the forced castration of sexual offenders in Germany during the Nazi period from 1934- 1945, is discussed in a cultural-historical introduction. A contemporary sample of 104 voluntary castrates (70% pedophiles, 25% aggressive sexual offenders, 3% exhibitionists, and 2% homosexuals) was examined. The survey was based on a representative follow-up investigation (response rate of 95%), covering approximately 20-25% of all orchidectomized sexual offenders between 1970 and 1980 in the Federal Republic of Germany. The results are contrasted with a comparison group who applied for castration during the same period but ultimately did not have the surgery. Sexual interest, libido, erection, and ejaculation generally decreased in 75% of the cases within 6 months. Approximately 10% remained sexually active for years on a slightly diminished level, whereas 15% reported sexual outlets over a longer period of time, but they required more intensive stimulation for sexual release. The post-operative recidivism rate for sexual crimes was 3% maximum, compared to 46% maximum for non-castrated applicants. Similar results between both samples were obtained in a special recidivism index which examined deprivation of liberty following approval of castration surgery. The social adjustment of the castrates, also seemed to be more favorable than that of the non-castrates. Of the castrates, approximately 70% were satisfied with the intervention, 20% were ambivalent and 10% were not satisfied.

Partnership after induced abortion: A prospective controlled study

To study the social and psychological consequences of induced abortion on the relationship between the pregnant woman and her partner, 92 patients seeking a socially indicated abortion, who had a stable partner at the time of abortion, were interviewed. Standardized psychological measures were used to assess their partnerships before abortion and on follow-up 1 year later. A control group of 92 patients (matched for age, marital status, duration of partnership, number of children, and educational background), drawn from a larger sample of women using safe contraceptive methods, completed the same psychological measures. Prior to abortion, partnerships in the study group showed considerably more conflicts and were less harmonious than in the control group. One year after the abortion, the number of separations in the study group was not significantly higher than in the control group, nor were there any remaining qualitative differences in the partnerships of either group. When separations occurred, they had been more frequently initiated by women in the study group than in the control group.

Anthropometrical Measurements and Androgen Levels in Males, Females, and Hormonally Untreated Female-to-Male Transsexuals

AbstractTo elucidate the relationship between body build, androgens, and transsexual gender identity, anthropometric measurements were assessed in 15 hormonally untreated female-to-male-transsexuals (FMT). Nineteen healthy women (CF) (

Denial of pregnancy as a reproductive dysfunction: A proposal for international classification systems

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[Standards for treatment and expert opinion on transsexuals. The German Society for Sexual Research, The Academy of Sexual medicine and the Society for Sexual Science].

= 22 years; 2 months), and 21 healthy men (CM) (

AIDS IN HAEMOPHILIACS, PARENTERAL DRUG ABUSERS, AND HOMOSEXUALS

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