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Gómez Á, Cerdán S, Pérez-Laso C, Ortega E, Pásaro E, Fernández R, Gómez-Gil E, Mora M, Marcos A, Del Cerro MCR, Guillamon A. Effects of adult male rat feminization treatments on brain morphology and metabolomic profile. Horm Behav 2020; 125:104839. [PMID: 32800765 DOI: 10.1016/j.yhbeh.2020.104839] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 08/04/2020] [Accepted: 08/06/2020] [Indexed: 12/11/2022]
Abstract
Body feminization, as part of gender affirmation process of transgender women, decreases the volume of their cortical and subcortical brain structures. In this work, we implement a rat model of adult male feminization which reproduces the results in the human brain and allows for the longitudinal investigation of the underlying structural and metabolic determinants in the brain of adult male rats undergoing feminization treatments. Structural MRI and Diffusion Tensor Imaging (DTI) were used to non-invasively monitor in vivo cortical brain volume and white matter microstructure over 30 days in adult male rats receiving estradiol (E2), estradiol plus cyproterone acetate (CA), an androgen receptor blocker and antigonadotropic agent (E2 + CA), or vehicle (control). Ex vivo cerebral metabolic profiles were assessed by 1H High Resolution Magic Angle Spinning NMR (1H HRMAS) at the end of the treatments in samples from brain regions dissected after focused microwave fixation (5 kW). We found that; a) Groups receiving E2 and E2 + CA showed a generalized bilateral decrease in cortical volume; b) the E2 + CA and, to a lesser extent, the E2 groups maintained fractional anisotropy values over the experiment while these values decreased in the control group; c) E2 treatment produced increases in the relative concentration of brain metabolites, including glutamate and glutamine and d) the glutamine relative concentration and fractional anisotropy were negatively correlated with total cortical volume. These results reveal, for the first time to our knowledge, that the volumetric decreases observed in trans women under cross-sex hormone treatment can be reproduced in a rat model. Estrogens are more potent drivers of brain changes in male rats than anti-androgen treatment.
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Affiliation(s)
- Ángel Gómez
- Facultad de Psicología, Universidad Nacional de Educación a Distancia, 28040 Madrid, Spain
| | - Sebastián Cerdán
- Instituto de Investigaciones Biomédicas "Alberto Sols", Consejo Superior de Investigaciones Científicas, 28029 Madrid, Spain
| | - Carmen Pérez-Laso
- Departamento de Psicobiología, Facultad de Psicología, Universidad Nacional de educación a Distancia, 28040 Madrid, Spain
| | - Esperanza Ortega
- Departamento de Bioquímica y Biología Molecular, Facultad de Medicina, Universidad de Granada, 18016 Granada, Spain
| | - Eduardo Pásaro
- Departamento de Psicología, Universidade da Coruña, 15071 A Coruña, Spain
| | - Rosa Fernández
- Departamento de Psicología, Universidade da Coruña, 15071 A Coruña, Spain
| | - Esther Gómez-Gil
- Unidad de Identidad de Género, Departamento de Psiquiatría, Hospital Clínic, 08036 Barcelona, Spain
| | - Mireia Mora
- Departamento de Endocrinología, Hospital Clínic, 08036 Barcelona, Spain
| | - Alberto Marcos
- Departamento de Psicobiología, Facultad de Psicología, Universidad Nacional de educación a Distancia, 28040 Madrid, Spain
| | - María Cruz Rodríguez Del Cerro
- Departamento de Psicobiología, Facultad de Psicología, Universidad Nacional de educación a Distancia, 28040 Madrid, Spain
| | - Antonio Guillamon
- Departamento de Psicobiología, Facultad de Psicología, Universidad Nacional de educación a Distancia, 28040 Madrid, Spain.
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Tack LJW, Craen M, Lapauw B, Goemaere S, Toye K, Kaufman JM, Vandewalle S, T'Sjoen G, Zmierczak HG, Cools M. Proandrogenic and Antiandrogenic Progestins in Transgender Youth: Differential Effects on Body Composition and Bone Metabolism. J Clin Endocrinol Metab 2018; 103:2147-2156. [PMID: 29672753 DOI: 10.1210/jc.2017-02316] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 04/11/2018] [Indexed: 02/13/2023]
Abstract
CONTEXT Progestins can be used to attenuate endogenous hormonal effects in late-pubertal transgender (trans) adolescents (Tanner stage B4/5 and G4/5). Currently, no data are available on the effects of progestins on the development of bone mass or body composition in trans youth. OBJECTIVE To study prospectively the evolution of body composition and bone mass in late-pubertal trans adolescents using the proandrogenic or antiandrogenic progestins lynestrenol (L) and cyproterone acetate (CA), respectively. DESIGN AND OUTCOME MEASUREMENTS Forty-four trans boys (Tanner B4/5) and 21 trans girls (Tanner G4/5) were treated with L or CA for 11.6 (4 to 40) and 10.6 (5 to 31) months, respectively. Anthropometry, grip strength, body composition, and bone mass, size, and density were determined by dual-energy X-ray absorptiometry and peripheral quantitative computed tomography before the start of progestin and before addition of cross-sex hormones. RESULTS Using L, lean mass [+3.2 kg (8.6%)] and grip strength [+3 kg (10.6%)] significantly increased, which coincided with a more masculine body shape in trans boys. Trans girls showed loss of lean mass [-2.2 kg (4.7%)], gain of fat mass [+1.5 kg (9.4%)], and decreased grip strength Z scores. CA limited normal bone expansion and impeded pubertal bone mass accrual, mostly at the lumbar spine [Z score: -0.765 to -1.145 (P = 0.002)]. L did not affect physiological bone development. CONCLUSION Proandrogenic and antiandrogenic progestins induce body composition changes in line with the desired appearance within 1 year of treatment. Bone health, especially at the lumbar spine, is of concern in trans girls, as bone mass accrual is severely affected by androgen suppressive therapy.
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Affiliation(s)
- Lloyd J W Tack
- Division of Pediatric Endocrinology, Department of Pediatrics, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Margarita Craen
- Division of Pediatric Endocrinology, Department of Pediatrics, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Bruno Lapauw
- Department of Endocrinology, Ghent University Hospital, Ghent University, Ghent, Belgium
- Unit for Osteoporosis and Metabolic Bone Diseases, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - Stefan Goemaere
- Department of Endocrinology, Ghent University Hospital, Ghent University, Ghent, Belgium
- Unit for Osteoporosis and Metabolic Bone Diseases, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - Kaatje Toye
- Department of Endocrinology, Ghent University Hospital, Ghent University, Ghent, Belgium
- Unit for Osteoporosis and Metabolic Bone Diseases, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - Jean-Marc Kaufman
- Department of Endocrinology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Sara Vandewalle
- Department of Endocrinology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Guy T'Sjoen
- Department of Endocrinology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Hans-Georg Zmierczak
- Department of Endocrinology, Ghent University Hospital, Ghent University, Ghent, Belgium
- Unit for Osteoporosis and Metabolic Bone Diseases, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - Martine Cools
- Division of Pediatric Endocrinology, Department of Pediatrics, Ghent University Hospital, Ghent University, Ghent, Belgium
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Mueller SC, Landré L, Wierckx K, T'Sjoen G. A Structural Magnetic Resonance Imaging Study in Transgender Persons on Cross-Sex Hormone Therapy. Neuroendocrinology 2017; 105:123-130. [PMID: 27490457 DOI: 10.1159/000448787] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 07/31/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND To date, research findings are inconsistent about whether the neuroanatomy in transgender persons resembles that of their natal sex or their gender identity. Moreover, few studies have examined the effects of long-term cross-sex hormonal treatment on neuroanatomy in this cohort. The purpose of the present study was to examine neuroanatomical differences in transgender persons after prolonged cross-sex hormone therapy. METHODS Eighteen transgender men (female-to-male), 17 transgender women (male-to-female), 30 nontransgender men (natal men), and 27 nontransgender women (natal women) completed a high-resolution structural magnetic resonance imaging scan at 3 T. Eligibility criteria for transgender persons were gender-affirming surgery and at least 2 years of cross-sex hormone therapy. Exclusion criteria for nontransgender persons were presence of psychiatric or neurological disorders. RESULTS The mean neuroanatomical volume for the amygdala, putamen, and corpus callosum differed between transgender women and natal women but not between transgender women and natal men. Differences between transgender men and natal men were found in several brain structures, including the medial temporal lobe structures and cerebellum. Differences between transgender men and natal women were found in the medial temporal lobe, nucleus accumbens, and 3rd ventricle. Sexual dimorphism between nontransgender men and women included larger cerebellar volumes and a smaller anterior corpus callosum in natal men than in natal women. The results remained stable after correcting for additional factors including age, total intracranial volume, anxiety, and depressive symptoms. CONCLUSIONS Neuroanatomical differences were region specific between transgender persons and their natal sex as well as their gender identity, raising the possibility of a localized influence of sex hormones on neuroanatomy.
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Affiliation(s)
- Sven C Mueller
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
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Guillamon A, Junque C, Gómez-Gil E. A Review of the Status of Brain Structure Research in Transsexualism. Arch Sex Behav 2016; 45:1615-48. [PMID: 27255307 PMCID: PMC4987404 DOI: 10.1007/s10508-016-0768-5] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 09/22/2015] [Accepted: 04/29/2016] [Indexed: 05/22/2023]
Abstract
The present review focuses on the brain structure of male-to-female (MtF) and female-to-male (FtM) homosexual transsexuals before and after cross-sex hormone treatment as shown by in vivo neuroimaging techniques. Cortical thickness and diffusion tensor imaging studies suggest that the brain of MtFs presents complex mixtures of masculine, feminine, and demasculinized regions, while FtMs show feminine, masculine, and defeminized regions. Consequently, the specific brain phenotypes proposed for MtFs and FtMs differ from those of both heterosexual males and females. These phenotypes have theoretical implications for brain intersexuality, asymmetry, and body perception in transsexuals as well as for Blanchard's hypothesis on sexual orientation in homosexual MtFs. Falling within the aegis of the neurohormonal theory of sex differences, we hypothesize that cortical differences between homosexual MtFs and FtMs and male and female controls are due to differently timed cortical thinning in different regions for each group. Cross-sex hormone studies have reported marked effects of the treatment on MtF and FtM brains. Their results are used to discuss the early postmortem histological studies of the MtF brain.
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Affiliation(s)
- Antonio Guillamon
- Departamento de Psicobiología, Universidad Nacional de Educación a Distancia, c/Juand del Rosal, 10, 28040, Madrid, Spain.
- Academia de Psicología de España, Madrid, Spain.
| | - Carme Junque
- Departamento de Psiquiatría y Psicobiología Clínica, Universidad de Barcelona, Barcelona, Spain
- Institute of Biomedical Research August Pi i Sunyer, Barcelona, Spain
| | - Esther Gómez-Gil
- Institute of Biomedical Research August Pi i Sunyer, Barcelona, Spain
- Unidad de Identidad de Género, Hospital Clinic, Barcelona, Spain
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Klink D, Caris M, Heijboer A, van Trotsenburg M, Rotteveel J. Bone mass in young adulthood following gonadotropin-releasing hormone analog treatment and cross-sex hormone treatment in adolescents with gender dysphoria. J Clin Endocrinol Metab 2015; 100:E270-5. [PMID: 25427144 DOI: 10.1210/jc.2014-2439] [Citation(s) in RCA: 136] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
CONTEXT Sex steroids are important for bone mass accrual. Adolescents with gender dysphoria (GD) treated with gonadotropin-releasing hormone analog (GnRHa) therapy are temporarily sex-steroid deprived until the addition of cross-sex hormones (CSH). The effect of this treatment on bone mineral density (BMD) in later life is not known. OBJECTIVE This study aimed to assess BMD development during GnRHa therapy and at age 22 years in young adults with GD who started sex reassignment (SR) during adolescence. DESIGN AND SETTING This was a longitudinal observational study at a tertiary referral center. PATIENTS Young adults diagnosed with gender identity disorder of adolescence (DSM IV-TR) who started SR in puberty and had undergone gonadectomy between June 1998 and August 2012 were included. In 34 subjects BMD development until the age of 22 years was analyzed. INTERVENTION GnRHa monotherapy (median duration in natal boys with GD [transwomen] and natal girls with GD [transmen] 1.3 and 1.5 y, respectively) followed by CSH (median duration in transwomen and transmen, 5.8 and 5.4 y, respectively) with discontinuation of GnRHa after gonadectomy. MAJOR OUTCOME MEASURES How BMD develops during SR until the age of 22 years. RESULTS AND CONCLUSION Between the start of GnRHa and age 22 years the lumbar areal BMD z score (for natal sex) in transwomen decreased significantly from -0.8 to -1.4 and in transmen there was a trend for decrease from 0.2 to -0.3. This suggests that the BMD was below their pretreatment potential and either attainment of peak bone mass has been delayed or peak bone mass itself is attenuated.
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Affiliation(s)
- Daniel Klink
- Center of Expertise on Gender Dysphoria (D.K., M.v.T., J.R.); Department of Pediatrics, Division of Endocrinology (D.K., M.C., J.R.); Department of Clinical Chemistry (A.H.); and Department of Obstetrics and Gynaecology (M.v.T.), VU University Medical Center, de Boelelaan 1118 1081 HZ Amsterdam, The Netherlands
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Sitek A, Fijałkowska M, Żądzińska E, Antoszewski B. Biometric characteristics of the pelvis in female-to-male transsexuals. Arch Sex Behav 2012; 41:1303-1313. [PMID: 22810992 DOI: 10.1007/s10508-012-9989-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Revised: 03/25/2011] [Accepted: 04/22/2012] [Indexed: 06/01/2023]
Abstract
The objective of the study was to evaluate the metric features of pelvises of 24 female-to-male (FtM) transsexuals as compared to control groups of 24 healthy males and 24 healthy females. The participants had their pelvises X-rayed with the same X-ray apparatus and in the same position. Seventeen measurements were taken on the basis of X-ray pictures of FtM transsexuals' pelvises and both comparison groups. Additionally, their body height was compared. The results showed that FtM transsexuals having female body height represent an intermediate size of three pelvic features and male values of five variables. In order to develop a model based on metric variables of the pelvis that would best discriminate the FtM transsexuals, the control females, and the control males, a discriminant analysis was applied. The model included four variables out of 17 metric features: the height of the pubic symphysis, the greatest pelvic breadth, the interischial distance, and the acetabular diameter. The model was found to be the best in discriminating males from females and FtM transsexuals, but considerably less effective in discriminating transsexuals from the two control groups. The results demonstrate that a number of FtM transsexuals' pelvic measurements reveal "masculinization," which confirms current results demonstrating a shift in the somatometric traits of transsexual females towards male traits. A discriminant analysis based only on pelvic metric features shows some differences between the size of the pelvis and chromosomal sex in FtM transsexuals, which might indicate a biological basis for gender identity disorder.
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Affiliation(s)
- Aneta Sitek
- Department of Anthropology, University of Lodz, Lodz, Poland
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Van Caenegem E, Wierckx K, Taes Y, Dedecker D, Van de Peer F, Toye K, Kaufman JM, T'Sjoen G. Bone mass, bone geometry, and body composition in female-to-male transsexual persons after long-term cross-sex hormonal therapy. J Clin Endocrinol Metab 2012; 97:2503-11. [PMID: 22564669 DOI: 10.1210/jc.2012-1187] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
CONTEXT Female-to-male transsexual persons (transsexual men) undergo extreme hormonal changes due to ovariectomy and testosterone substitution, allowing studies on sex steroid effects on bone geometry and physiology in the adult. OBJECTIVE The objective of the study was to examine the effects of cross-gender sex steroid exposure on volumetric bone parameters in transsexual men. DESIGN This was a cross-sectional study. SETTING Participants were recruited from the Center for Sexology and Gender Problems at the Ghent University Hospital (Ghent, Belgium). PARTICIPANTS Fifty transsexual men after sex reassignment surgery with 50 age-matched control women and an additional 16 transsexual men before testosterone substitution and sex reassignment surgery with 16 control women participated in the study. MAIN OUTCOME MEASURES The main outcome measures were areal and volumetric bone parameters using dual-energy X-ray absorptiometry and peripheral quantitative computed tomography, body composition (dual-energy X-ray absorptiometry), sex steroids, markers of bone turnover and grip strength. RESULTS Before hormonal treatment, transsexual men had similar body composition and bone geometry as female controls. The transsexual men on long-term testosterone therapy, however, demonstrated a higher lean body mass and muscle mass and a greater grip strength as well as a lower body and subcutaneous fat mass and a larger waist and smaller hip circumference compared with female controls (all P < 0.001). We observed a larger radial cortical bone size (P < 0.001) and lower cortical volumetric bone mineral density at the radius and tibia (P < 0.05) in transsexual men on testosterone therapy. CONCLUSIONS Transsexual men on testosterone substitution therapy present with a different body composition with more muscle mass and strength and less fat mass as well as an altered bone geometry with larger bones compared with female controls.
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Affiliation(s)
- E Van Caenegem
- Department of Endocrinology, Ghent University Hospital De Pintelaan 185, 9000 Ghent, Belgium.
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Gabrielli E, Ferraioli G, Ferraris L, Riva A, Galli M, Filice C, Gervasoni C. Enfuvirtide administration in HIV-positive transgender patient with soft tissue augmentation: US evaluation. New Microbiol 2010; 33:263-265. [PMID: 20954446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Enfuvirtide is a large protein that should be injected subcutaneously to ensure an appropriate absorption. Here we report the case of a transgender HIV-positive patient receiving enfuvirtide with an individualized background regimen of antiretroviral drugs, who had previously undergone liquid silicone oil injections. We performed US scan to detect silicone-free areas for following enfuvirtide injections. US can be useful in the correct management of those patients with liquid silicone oil soft tissue augmentation who require subcutaneously injected drugs.
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Affiliation(s)
- Eugenia Gabrielli
- Clinical Science Department, Section of Infectious Diseases, University of Milan, L. Sacco Hospital, Milan, Italy
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Abstract
Cricothyroid approximation raises the vocal pitch by simulating contraction of the cricothyroid muscle with sutures. The aim of this study was to determine the role of spiral CT in patients scheduled for cricothyroid approximation. 29 transsexual patients were examined with spiral CT prior to and after laryngoplastic surgery. CT findings were correlated with phonographic findings in all patients. The average reduction of the cricothyroid distance was 6 mm (range 2-10 mm). Vocal pitch elevation was greatest in patients with the largest reduction of the cricothyroid distance. CT accurately determines the cricothyroid distance prior to and after surgery and is an ideal method for follow-up, especially in post-operative reversion towards a lower pitch. In addition, CT provides important data in determining the most appropriate extent and site of intracordal intervention to achieve a desired pitch elevation.
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Affiliation(s)
- D Pickuth
- Department of Diagnostic Radiology, Martin-Luther-University, Faculty of Medicine, Halle/Saale, Germany
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Abstract
OBJECTIVE We studied the pretreatment hormone profile and ovarian ultrasound appearance of female-to-male transsexuals. DESIGN Female-to-male transsexuals who were seen in the local Gender Identity Clinic were examined after psychiatric assessment. RESULTS Sixteen patients were assessed. Approximately 50% had symptoms and signs of the polycystic ovary syndrome (PCOS) and 15 had a pelvic ultrasound diagnosis of polycystic ovaries. The endocrine profiles of the patients were not markedly abnormal and were compatible with the diagnosis of PCOS. CONCLUSIONS Polycystic ovaries and the polycystic ovary syndrome are a common finding in female-to-male transsexuals who have had no previous exposure to exogenous androgen therapy.
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Affiliation(s)
- A H Balen
- Department of Reproductive Endocrinology, Cobbold Laboratories, Middlesex Hospital, London, UK
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Lame EL. Unusual gas shadow in pelvis of asymptomatic patient. JAMA 1977; 238:1287-8. [PMID: 578185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Benz G, Willich E. [Radiological aspects in children's gynecology]. Fortschr Med 1974; 92:635-40. [PMID: 4829460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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