Silvia Cerpolini

Effect of Long‐Term Testosterone Administration on the Endometrium of Female‐to‐Male (FtM) Transsexuals

INTRODUCTION Long term safety of testosterone (T) administration in women is still unknown. In particular few and discordant data exists on the effects of T on the endometrium. AIM The aim of this study was to investigate the effects of long-term T treatment on endometrium histology and proliferation in female to male transsexual subjects (FtM). We compared these endometria with those of young women in the proliferative phase (PM) of the cycle and with those of post menopausal women (M). METHOD Endometrial samples from 27 FtM treated with T (intramuscular injection of 100 mg Testoviron Depot /10 days for at least one year), 30 M undergoing vaginal hysterectomy, and 13 PM undergoing hysteroscopy for infertility problems were collected. Endometrial proliferation was evaluated on the basis of histopathology and expression of the proliferation marker Ki-67. Both M and PM women had not received any hormonal treatment for at least one year. MAIN OUTCOME MEASURE Circulating total testosterone (TT), estradiol (E), progesterone (P), insulin and glucose levels were measured in FtM and PM subjects. RESULTS FtM had received T for 33.6 +/- 21.3 months (mean +/- SD). In FtM subjects, histological analysis found inactive endometrium similar to the atrophic menopausal endometrium. The expression of Ki-67 in the glands, stroma and glands and stroma together was significantly (p < 0.0005) lower in FtM than in PM women and was similar in the FtM and M groups. Small polyps were detected in 5 of the 27 FtM subjects. CONCLUSIONS In conclusion our data suggest that exogenous T administration does not stimulate endometrial proliferation in FtM transsexuals and indeed may have atrophic effects.

A Prospective Study on Sexual Function and Mood in Female-to-Male Transsexuals During Testosterone Administration and After Sex Reassignment Surgery

Testosterone administration in female-to-male transsexual subjects aims to develop and maintain the characteristics of the desired sex. Very little data exists on its effects on sexuality of female-to-male transsexuals. The aim of this study was to evaluate sexual function and mood of female-to-male transsexuals from their first visit, throughout testosterone administration and after sex reassignment surgery. Participants were 50 female-to-male transsexual subjects who completed questionnaires assessing sexual parameters and mood. The authors measured reproductive hormones and hematological parameters. The results suggest a positive effect of testosterone treatment on sexual function and mood in female-to-male transsexual subjects.

Recent advances in hormonal male contraception

Hormones inhibit fertility in men by suppressing sperm production. Testosterone-enanthate induced azoospermia has proven to provide optimal contraceptive protection. Preliminary studies have shown that testosterone alone or androgen-progestin combinations induce profound sperm suppression in the Eastern and white populations, respectively. Thus, these regimens may represent viable options for male contraception. New long-acting androgen formulations represent a major advancement in this field, allowing for the development of more acceptable and effective regimens.

Cyproterone acetate vs leuprolide acetate in combination with transdermal oestradiol in transwomen: a comparison of safety and effectiveness.

To retrospectively compare the effectiveness and safety of 1‐year administration of transdermal oestradiol (TE) with cyproterone acetate (CPA) or leuprolide acetate (Leu) in transwomen.

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.

Testosterone undecanoate and testosterone enanthate injections are both effective and safe in transmen over 5 years of administration

To retrospectively evaluate and compare safety and efficacy of short and long‐acting testosterone (T) parenteral formulations over 5 years in transmen.

Potere procreativo e contraccezione maschile

Negli ultimi anni la ricerca scientifica sui metodi contraccettivi si e interessata allo sviluppo di metodi ormonali anche per l’uomo, rispondendo cosi alla necessita di una maggior condivisione dei rischi e delle responsabilita della contraccezione nonche ad una maggiore parita tra i sessi e ad uno sviluppo della pianificazione familiare. L’Eiaculazione precoce (EP) colpisce circa il 30% degli uomini di tutte le eta determinando un impatto negativo sulla qualita della vita e della relazione di coppia. La psicoterapia moderna per la cura della EP prevede l’integrazione di diversi approcci: psicodinamico, sistemico, cognitivo e comportamentale, all’interno di un modello psicoterapeutico a breve termine.

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.

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.

Contraccezione ormonale maschile

RiassuntoLa somministrazione combinata di androgeno e di un progestinico induce una profonda soppressione della spermatogenesi, rappresentando quindi un promettente regime contraccettivo per l’uomo.