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L J G Gooren - One of the best experts on this subject based on the ideXlab platform.
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patho physiology of cross sex hormone administration to transsexual people the potential impact of male female genetic differences
Andrologia, 2015Co-Authors: L J G Gooren, Baudewijntje P C Kreukels, Bruno Lapauw, Eric J GiltayAbstract:There is a limited body of knowledge of desired and undesired effects of cross-sex hormones in transsexual people. Little attention has been given to the fact that chromosomal configurations, 46,XY in male-to-female Transsexuals subjects (MtoF) and 46,XX in female-to-male transsexual subjects (FtoM), obviously, remain unchanged. These differences in their genomes cause sex differences in the functions of cells. This study reviews sex differences in metabolism/cardiovascular pathology, immune mechanisms, bone (patho)physiology and brain functions and examines whether they are, maybe partially, determined by genetic mechanisms rather than by (cross-sex) hormones. There do not appear to be major genetic impacts on the changes in bone physiology. Also immune functions are rather unaffected and the evidence for an increase of autoimmune disease in MtoF is preliminary. Brain functions of Transsexuals may have differed from controls before cross-sex hormones; they do undergo shifts upon cross-sex hormone treatment, but there is no evidence for changes in sex-specific brain disease. The prevalence of cardiovascular disease is higher in MtoF receiving oestrogens than in FtoM receiving androgens. While type of oestrogen and route of administration might be significant, it is reasonable to speculate that nonhormonal/genetic factors play a role.
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a long term follow up study of mortality in Transsexuals receiving treatment with cross sex hormones
European Journal of Endocrinology, 2011Co-Authors: H Asscheman, J Megens, Eric J Giltay, W P De Ronde, M A A Van Trotsenburg, L J G GoorenAbstract:Objective: Adverse effects of long-term cross-sex hormone administration to Transsexuals are not well documented. We assessed mortality rates in transsexual subjects receiving long-term cross-sex hormones. Design: A cohort study with a median follow-up of 18.5 years at a university gender clinic. Methods: Mortality data and the standardized mortality rate were compared with the general population in 966 male-to-female (MtF) and 365 female-to-male (FtM) Transsexuals, who started cross-sex hormones before July 1, 1997. Follow-up was at least 1 year. MtF Transsexuals received treatment with different high-dose estrogen regimens and cyproterone acetate 100 mg/day. FtM Transsexuals received parenteral/oral testosterone esters or testosterone gel. After surgical sex reassignment, hormonal treatment was continued with lower doses. Results: In the MtF group, total mortality was 51% higher than in the general population, mainly from increased mortality rates due to suicide, acquired immunodeficiency syndrome, cardiovascular disease, drug abuse, and unknown cause. No increase was observed in total cancer mortality, but lung and hematological cancer mortality rates were elevated. Current, but not past ethinyl estradiol use was associated with an independent threefold increased risk of cardiovascular death. In FtM Transsexuals, total mortality and cause-specific mortality were not significantly different from those of the general population. Conclusions: The increased mortality in hormone-treated MtF Transsexuals was mainly due to nonhormone-related causes, but ethinyl estradiol may increase the risk of cardiovascular death. In the FtM Transsexuals, use of testosterone in doses used for hypogonadal men seemed safe.
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male to female Transsexuals have female neuron numbers in a limbic nucleus
The Journal of Clinical Endocrinology and Metabolism, 2000Co-Authors: Frank P M Kruijver, L J G Gooren, Jiangning Zhou, Chris W Pool, Michel A Hofman, D F SwaabAbstract:Transsexuals experience themselves as being of the opposite sex, despite having the biological characteristics of one sex. A crucial question resulting from a previous brain study in male-to-female Transsexuals was whether the reported difference according to gender identity in the central part of the bed nucleus of the stria terminalis (BSTc) was based on a neuronal difference in the BSTc itself or just a reflection of a difference in vasoactive intestinal polypeptide innervation from the amygdala, which was used as a marker. Therefore, we determined in 42 subjects the number of somatostatin-expressing neurons in the BSTc in relation to sex, sexual orientation, gender identity, and past or present hormonal status. Regardless of sexual orientation, men had almost twice as many somatostatin neurons as women (P < 0.006). The number of neurons in the BSTc of male-to-female Transsexuals was similar to that of the females (P = 0.83). In contrast, the neuron number of a female-to-male transsexual was found to be in the male range. Hormone treatment or sex hormone level variations in adulthood did not seem to have influenced BSTc neuron numbers. The present findings of somatostatin neuronal sex differences in the BSTc and its sex reversal in the transsexual brain clearly support the paradigm that in Transsexuals sexual differentiation of the brain and genitals may go into opposite directions and point to a neurobiological basis of gender identity disorder.
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mortality and morbidity in transsexual subjects treated with cross sex hormones
Clinical Endocrinology, 1997Co-Authors: P J M Van Kesteren, H Asscheman, J Megens, L J G GoorenAbstract:OBJECTIVE The optimum steroid hormone treatment regimes for transsexual subjects has not yet been established. We have investigated the mortality and morbidity figures in a large group of transsexual subjects receiving cross-sex hormone treatment. DESIGN A retrospective, descriptive study in a university teaching hospital. SUBJECTS Eight hundred and sixteen male-to-female (M → F) and 293 female-to-male (F → M) Transsexuals. INTERVENTIONS Subjects had been treated with cross-sex hormones for a total of 10 152 patient-years. OUTCOME MEASURES Standardized mortality and incidence ratios were calculated from the general Dutch population (age- and gender-adjusted) and were also compared to side effects of cross-sex hormones in Transsexuals reported in the literature. RESULTS In both the M → F and F → M Transsexuals, total mortality was not higher than in the general population and, largely, the observed mortality could not be related to hormone treatment. Venous thromboembolism was the major complication in M → F Transsexuals treated with oral oestrogens and anti-androgens, but fewer cases were observed since the introduction of transdermal oestradiol in the treatment of Transsexuals over 40 years of age. No cases of breast carcinoma but one case of prostatic carcinoma were encountered in our population. No serious morbidity was observed which could be related to androgen treatment in the F → M Transsexuals. CONCLUSION Mortality in male-to-female and female-to-male Transsexuals is not increased during cross-sex hormone treatment. Transdermal oestradiol administration is recommended in male-to-female Transsexuals, particularly in the population over 40 years in whom a high incidence of venous thromboembolism was observed with oral oestrogens. It seems that in view of the deep psychological needs of Transsexuals to undergo sex reassignment, our treatment schedule of cross-sex hormone administration is acceptably safe.
Gennaro Selvaggi - One of the best experts on this subject based on the ideXlab platform.
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Titanium-bone-anchored penile epithesis: preoperative planning and immediate postoperative results.
Journal of Plastic Surgery and Hand Surgery, 2014Co-Authors: Gennaro Selvaggi, Rickard Brånemark, Anna Elander, Mattias Lidén, Joacim StalforsAbstract:The principle of osseointegration is accepted and used in reconstructive surgery. This study presents the first series of five patients where titanium implants have been implanted into the pubic bones of female-to-male (FTM) transsexual patients, in order to attach a “bone-anchored” penile epithesis. Following patient selection based on patients’ wishes, pubic bones of 10 FTM Transsexuals were analysed by CT-scan and a virtual planning was made. A surgical plan was also developed. To date, five FTM Transsexuals have undergone the two-stage surgery. During stage-1, two titanium implants (“fixtures”) are implanted onto the pubic bone. Four weeks postop, a new CT scan is performed to analyze osseointegration and the final implant position. During stage-2, the soft tissue of the pubic area is reduced; abutments are inserted and passed through the skin. A few weeks after stage 2 surgery, a penile epithesis is connected to the skin-penetrating titanium implants. Two out of 10 patients who received preoperative CT scan presented with smaller pubic bones, not able to accommodate the fixtures as chosen originally. Preoperative virtual planning is crucial for the selection of the appropriate implants size. The stage-1 and stage-2 surgery occurred uneventfully in all five patients. One patient presented with a wound infection 1 week after stage-2 surgery. Postoperative CT scan demonstrates implant osseointegration in all cases. This experimental clinical study demonstrates that titanium osseointegration is feasible ontothe pubic bone. Thisnew approach for penile reconstruction constitutes another alternative for both transsexual patients and cases following genital development disorders, post-trauma and surgery.
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The development of sex reassignment surgery in Thailand: a social perspective.
The Scientific World Journal, 2014Co-Authors: Prayuth Chokrungvaranont, Gennaro Selvaggi, Pornthep Pungrasmi, Apichai Angspatt, Sirachai Jindarak, Poonpismai Suwajo, Preecha TiewtranonAbstract:This paper reviews the development of gender reassignment in Thailand during the period of 1975–2012, in terms of social attitude, epidemiology, surgical patients' profile, law and regulation, religion, and patients' path from psychiatric assessment to surgery. Thailand healthcare for transsexual patients is described. Figures related to the number of sex reassignment surgeries performed in Thailand over the past 30 years are reported. Transsexual individuals are only apparently integrated within the Thail society: the law system of Thailand in fact, does not guarantee to Transsexuals the same rights as in other Western countries; the governmental healthcare does not offer free treatments for transsexual patients. In favor of the transsexual healthcare, instead, the Medical Council of Thailand recently published a policy entitled “Criteria for the treatment of sex change, Census 2009.” The goal of this policy was to improve the care of transsexual patients in Thailand, by implementing the Standards of Care of the World Professional Association of Transgender Health. Currently, in Thailand, there are 6 major private groups performing sex reassignment surgery, and mostly performing surgery to patients coming from abroad. Particularly, the largest of these (Preecha's group) has performed nearly 3000 vaginoplasties for male-to-female Transsexuals in the last 30 years.
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scrotal reconstruction in female to male Transsexuals a novel scrotoplasty
Plastic and Reconstructive Surgery, 2009Co-Authors: Gennaro Selvaggi, Piet Hoebeke, G De Cuypere, Peter Ceulemans, Moustapha Hamdi, Koenraad Van Landuyt, Phillip Blondeel, S MonstreyAbstract:Background: One of the goals of genital construction in female-to-male Transsexuals is the creation of an aesthetically acceptable result, both for phallus and scrotum, leaving minimal morbidity and recreating function. In the last 15 years, Transsexuals have become more demanding, and scrotoplasty has received more attention than before. Traditional flaps for scrotal reconstruction in a biological male do not really apply in Transsexuals: the labia majora seem to achieve the best results; still, they may not provide enough tissue and can be located much too posteriorly. Methods: Since November of 1993, more than 300 scrotal reconstructions (and radial forearm flap phalloplasties) have been performed in female-to-male Transsexuals by the authors' gender team. Based on the authors' large experience, they modified previous techniques and developed a novel scrotoplasty consisting of a V-Y advancement of the major labia together with a rotation of these superiorly based labial flaps. Refinements (to achieve better sensation and shaping) are described. Twelve months after the original operation, one testicle implant and erection prosthesis procedures were performed. Results: No major complications related to scrotoplasty occurred in the authors' series. Patients were all pleased at short- or long-term follow-up with their scrotum, located in its natural position in front of the legs. Conclusion: The authors' novel scrotoplasty can become the ultimate surgical technique to reconstruct the scrotum in female-to-male transsexual patients, further improving the final cosmetic result, with the possibility of enhanced erogenous sensitivity.
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long term follow up psychosocial outcome of belgian Transsexuals after sex reassignment surgery
Sexologies, 2006Co-Authors: G De Cuypere, Gennaro Selvaggi, Piet Hoebeke, Els Elaut, Gunter Heylens, G Van Maele, Guy Tsjoen, Robert Rubens, Robert Rubens, Gunter Heylens, Els Elaut, S MonstreyAbstract:Abstract Background To establish the benefit of sex reassignment surgery (SRS) for persons with a gender identity disorder, follow-up studies comprising large numbers of operated Transsexuals are still needed. Aims The authors wanted to assess how the Transsexuals who had been treated by the Ghent multidisciplinary gender team since 1985, were functioning psychologically, socially and professionally after a longer period. They also explored some prognostic factors with a view to refining the procedure. Method From 107 Dutch-speaking Transsexuals who had undergone SRS between 1986 and 2001, 62 (35 male-to-females and 27 female-to-males) completed various questionnaires and were personally interviewed by researchers, who had not been involved in the subjects' initial assessment or treatment. Results On the GAF (DSM-IV) scale the female-to-male Transsexuals scored significantly higher than the male-to-females (85.2 versus 76.2). While no difference in psychological functioning (SCL-90) was observed between the study group and a normal population, subjects with a pre-existing psychopathology were found to have retained more psychological symptoms. The subjects proclaimed an overall positive change in their family and social life. None of them showed any regrets about the SRS. A homosexual orientation, a younger age when applying for SRS, and an attractive physical appearance were positive prognostic factors. Conclusion While sex reassignment treatment is an effective therapy for Transsexuals, also in the long term, the postoperative transsexual remains a fragile person in some respects.
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Repair of vaginal prolapse following penoscrotal flap vaginoplasty in a male-to-female transsexual.
Gynecologic and Obstetric Investigation, 2002Co-Authors: Giuseppe Loverro, Carlo Bettocchi, Michele Battaglia, Gennaro Cormio, Gennaro Selvaggi, Pasquale Di Tonno, Francesco Paolo SelvaggiAbstract:Penis and testicle amputation, vaginoplasty, and clitoroplasty are procedures that help male-to-female Transsexuals to accept their body and to increase psychosocial well-being. We describe a successful correction of prolapse of the neovagina with abdominovaginal sacropexy in a male-to-female transsexual who had undergone penoscrotal flap vaginoplasty. Although the reasons for a neovaginal prolapse are not completely known, in our case vaginal sacropexy was successful, with good functional and cosmetic results.
H Asscheman - One of the best experts on this subject based on the ideXlab platform.
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a long term follow up study of mortality in Transsexuals receiving treatment with cross sex hormones
European Journal of Endocrinology, 2011Co-Authors: H Asscheman, J Megens, Eric J Giltay, W P De Ronde, M A A Van Trotsenburg, L J G GoorenAbstract:Objective: Adverse effects of long-term cross-sex hormone administration to Transsexuals are not well documented. We assessed mortality rates in transsexual subjects receiving long-term cross-sex hormones. Design: A cohort study with a median follow-up of 18.5 years at a university gender clinic. Methods: Mortality data and the standardized mortality rate were compared with the general population in 966 male-to-female (MtF) and 365 female-to-male (FtM) Transsexuals, who started cross-sex hormones before July 1, 1997. Follow-up was at least 1 year. MtF Transsexuals received treatment with different high-dose estrogen regimens and cyproterone acetate 100 mg/day. FtM Transsexuals received parenteral/oral testosterone esters or testosterone gel. After surgical sex reassignment, hormonal treatment was continued with lower doses. Results: In the MtF group, total mortality was 51% higher than in the general population, mainly from increased mortality rates due to suicide, acquired immunodeficiency syndrome, cardiovascular disease, drug abuse, and unknown cause. No increase was observed in total cancer mortality, but lung and hematological cancer mortality rates were elevated. Current, but not past ethinyl estradiol use was associated with an independent threefold increased risk of cardiovascular death. In FtM Transsexuals, total mortality and cause-specific mortality were not significantly different from those of the general population. Conclusions: The increased mortality in hormone-treated MtF Transsexuals was mainly due to nonhormone-related causes, but ethinyl estradiol may increase the risk of cardiovascular death. In the FtM Transsexuals, use of testosterone in doses used for hypogonadal men seemed safe.
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mortality and morbidity in transsexual subjects treated with cross sex hormones
Clinical Endocrinology, 1997Co-Authors: P J M Van Kesteren, H Asscheman, J Megens, L J G GoorenAbstract:OBJECTIVE The optimum steroid hormone treatment regimes for transsexual subjects has not yet been established. We have investigated the mortality and morbidity figures in a large group of transsexual subjects receiving cross-sex hormone treatment. DESIGN A retrospective, descriptive study in a university teaching hospital. SUBJECTS Eight hundred and sixteen male-to-female (M → F) and 293 female-to-male (F → M) Transsexuals. INTERVENTIONS Subjects had been treated with cross-sex hormones for a total of 10 152 patient-years. OUTCOME MEASURES Standardized mortality and incidence ratios were calculated from the general Dutch population (age- and gender-adjusted) and were also compared to side effects of cross-sex hormones in Transsexuals reported in the literature. RESULTS In both the M → F and F → M Transsexuals, total mortality was not higher than in the general population and, largely, the observed mortality could not be related to hormone treatment. Venous thromboembolism was the major complication in M → F Transsexuals treated with oral oestrogens and anti-androgens, but fewer cases were observed since the introduction of transdermal oestradiol in the treatment of Transsexuals over 40 years of age. No cases of breast carcinoma but one case of prostatic carcinoma were encountered in our population. No serious morbidity was observed which could be related to androgen treatment in the F → M Transsexuals. CONCLUSION Mortality in male-to-female and female-to-male Transsexuals is not increased during cross-sex hormone treatment. Transdermal oestradiol administration is recommended in male-to-female Transsexuals, particularly in the population over 40 years in whom a high incidence of venous thromboembolism was observed with oral oestrogens. It seems that in view of the deep psychological needs of Transsexuals to undergo sex reassignment, our treatment schedule of cross-sex hormone administration is acceptably safe.
Clemens B Tempfer - One of the best experts on this subject based on the ideXlab platform.
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incidence of thrombophilia and venous thrombosis in Transsexuals under cross sex hormone therapy
Fertility and Sterility, 2010Co-Authors: Johannes Ott, Ulrike Kaufmann, Evakatrin Bentz, Johannes C Huber, Clemens B TempferAbstract:Objective To evaluate the incidence of venous thromboembolism (VTE) in transsexual patients and the value of screening for thrombophilia in this population. Design Retrospective cohort study. Setting Academic research institution. Patient(s) Two hundred fifty-one Transsexuals (162 male-to-female [MtF] and 89 female-to-male [FtM] Transsexuals). Intervention(s) Screening for activated protein C (aPC) resistance, antithrombin III, free protein S antigen, and protein C deficiency. Main Outcome Measure(s) Incidence of thrombophilic defects and VTE during cross-sex hormone therapy. Result(s) Activated protein C resistance was detected in 18/251 patients (7.2%), and protein C deficiency was detected in one patient (0.4%). None of the patients developed VTE under cross-sex hormone therapy during a mean of 64.2 ± 38.0 months. There was no difference in the incidence of thrombophilia comparing MtF and FtM Transsexuals (8.0% [13/162] vs. 5.6% [5/89], respectively). Conclusion(s) VTE during cross-sex hormone therapy is rare. General screening for thrombophilic defects in transsexual patients is not recommended. Cross-sex hormone therapy is feasible in MtF as well as in FtM patients with aPC resistance.
S Monstrey - One of the best experts on this subject based on the ideXlab platform.
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scrotal reconstruction in female to male Transsexuals a novel scrotoplasty
Plastic and Reconstructive Surgery, 2009Co-Authors: Gennaro Selvaggi, Piet Hoebeke, G De Cuypere, Peter Ceulemans, Moustapha Hamdi, Koenraad Van Landuyt, Phillip Blondeel, S MonstreyAbstract:Background: One of the goals of genital construction in female-to-male Transsexuals is the creation of an aesthetically acceptable result, both for phallus and scrotum, leaving minimal morbidity and recreating function. In the last 15 years, Transsexuals have become more demanding, and scrotoplasty has received more attention than before. Traditional flaps for scrotal reconstruction in a biological male do not really apply in Transsexuals: the labia majora seem to achieve the best results; still, they may not provide enough tissue and can be located much too posteriorly. Methods: Since November of 1993, more than 300 scrotal reconstructions (and radial forearm flap phalloplasties) have been performed in female-to-male Transsexuals by the authors' gender team. Based on the authors' large experience, they modified previous techniques and developed a novel scrotoplasty consisting of a V-Y advancement of the major labia together with a rotation of these superiorly based labial flaps. Refinements (to achieve better sensation and shaping) are described. Twelve months after the original operation, one testicle implant and erection prosthesis procedures were performed. Results: No major complications related to scrotoplasty occurred in the authors' series. Patients were all pleased at short- or long-term follow-up with their scrotum, located in its natural position in front of the legs. Conclusion: The authors' novel scrotoplasty can become the ultimate surgical technique to reconstruct the scrotum in female-to-male transsexual patients, further improving the final cosmetic result, with the possibility of enhanced erogenous sensitivity.
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Impact of voice in Transsexuals
International Journal of Transgenderism, 2006Co-Authors: Guy T'sjoen, Piet Hoebeke, S Monstrey, Griet De Cuypere, Robert Rubens, John Van Borsel, Petra De Sutter, Mieke Moerman, Els Feyen, Robert Rubens, Guy T'sjoen, Griet De CuypereAbstract:ABSTRACT Transsexualism implies that an anatomically normal individual feels that he or she is actually a member of the opposite sex. Treatment usually includes real-life experience along with hormone therapy and sex reassignment surgery. Voice modification surgery may be necessary, as pass ability in general is still in a large extent dependent on the aspects of voice in transsexual people. Often male-to-female patients report being addressed in telephone conversations as their genetic gender, which is experienced as a disability. The purpose of this study was to evaluate the impact of voice on the quality of life in Transsexuals. In order to detect the disability caused by a voice disorder, the validated assessment method the Voice Handicap Inventory (VHI) was used. An additional question about the way patients were addressed in a telephone conversation was added. As part of a study describing general health in transsexual persons, done at the Ghent University Hospital Belgium, a total of 48 patients we...
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long term follow up psychosocial outcome of belgian Transsexuals after sex reassignment surgery
Sexologies, 2006Co-Authors: G De Cuypere, Gennaro Selvaggi, Piet Hoebeke, Els Elaut, Gunter Heylens, G Van Maele, Guy Tsjoen, Robert Rubens, Robert Rubens, Gunter Heylens, Els Elaut, S MonstreyAbstract:Abstract Background To establish the benefit of sex reassignment surgery (SRS) for persons with a gender identity disorder, follow-up studies comprising large numbers of operated Transsexuals are still needed. Aims The authors wanted to assess how the Transsexuals who had been treated by the Ghent multidisciplinary gender team since 1985, were functioning psychologically, socially and professionally after a longer period. They also explored some prognostic factors with a view to refining the procedure. Method From 107 Dutch-speaking Transsexuals who had undergone SRS between 1986 and 2001, 62 (35 male-to-females and 27 female-to-males) completed various questionnaires and were personally interviewed by researchers, who had not been involved in the subjects' initial assessment or treatment. Results On the GAF (DSM-IV) scale the female-to-male Transsexuals scored significantly higher than the male-to-females (85.2 versus 76.2). While no difference in psychological functioning (SCL-90) was observed between the study group and a normal population, subjects with a pre-existing psychopathology were found to have retained more psychological symptoms. The subjects proclaimed an overall positive change in their family and social life. None of them showed any regrets about the SRS. A homosexual orientation, a younger age when applying for SRS, and an attractive physical appearance were positive prognostic factors. Conclusion While sex reassignment treatment is an effective therapy for Transsexuals, also in the long term, the postoperative transsexual remains a fragile person in some respects.
