A higher rate of hyperandrogenic disorders in female-to-male transsexuals
A higher rate of hyperandrogenic disorders in female-to-male transsexuals
复制标题
DOI：
10.1016/s0306-4530(97)00033-4
复制
发表时间：
1997-07-01
影响因子：
3.7
通讯作者：
Wille, R
中科院分区：
文献类型：
--
作者：
Bosinski, HAG;Peter, M;Wille, R
为了阐明女性易性症(FM-TS)的病因学，对16名年龄19岁7个月(19；7)至44岁8个月(44；8)的未经治疗的女性变性者(FMT)的年度样本中的12人进行了性医学问卷调查、体格检查和内分泌检查。对照组15例，年龄19岁2个月(19；2)~36岁1个月(36；1)(男性22；7)，年龄19岁2个月(19；2)，无性别认同障碍，未服用激素(含避孕药)。检测基础水平：睾酮(T；ng/dl)、雄烯二酮(A4；ng/dl)、脱氢表雄酮硫酸盐(DHEAS；ng/ml)、黄体生成素(Lh；Iu/1)、卵泡刺激素(FSH；Iu/1)和性激素结合球蛋白(SHBG；Mu g/dl)。对所有受试者进行标准的单剂量ACTH刺激试验(250mUg ACTH IV；Synacten)。分别于刺激前和刺激后60min测定醛固酮(ALDO)、皮质酮(B)、脱氧皮质酮(DOC)、孕酮(青蛙)、17-羟孕酮(170hp)、11-脱氧皮质醇(S)、皮质醇(F)、皮质醇(E)、孕烯醇酮(PREG)和17-羟孕烯醇酮(OHPREG)。12例FMT中有9例(20例；11~44岁；8例，男性27例；5例；男性29.1+/-7.5例)未行经阴道超声检查。结果表明，至少有一种雄激素的FMT(83.3%)和5种CF值(33.3%)高于正常值。FMT组T和A4水平显著高于CF组(T：54.0+/-13.8vs.41.1+/-12.8；A4：244.8+/-73.0vs.190.5+/-49.3；p<；0.05)，而DHEAS、SHBG、LH和FSH在两组间无差异。游离T(T/SHBG)比值FMT(72.0+/-67.6)高于CF(26.4+/-15.1)。FMT组的17OHP、OHPREG和DOC基线水平高于CF组(P<0.05)。刺激ACTH后，FMT组的17OHP和OHPREG仍高于CF组(P<0.05)。单例ACTH刺激试验结合体检发现非经典型先天性肾上腺增生症(NC-CAH)6例(50%)，2例CF(13.3%)。经阴道超声检查的9例FMT中有8例(88.9%；16例)有多囊卵巢(PCO)。月经过少或月经不调(16例FMT中81.7%，CF为0%)、多毛症(16例FMT中56.2%，15例CF中13.3%)和肥胖症(25.0%，0%)在FMT中常见，而在CF中则不常见。伴有多囊卵巢综合征(PCOS)的高雄激素血症和肾上腺皮质对ACTH的高反应性似乎是FMT的常见表现。这为FM-TS的发生提供了荷尔蒙因素的支持。因为PCOS和NC-CAH在女性人群中的患病率高于FM-TS。这一因素的真实性质及其与环境影响的相互作用仍不清楚。(C)1997年爱思唯尔科学有限公司。
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/1), follicle stimulating hormone (FSH; IU/1), and sex-hormone binding globuline (SHBG; mu g/dl) were measured. A standard single-dose ACTH stimulation test (250 mu g ACTH IV; Synacthen) was performed with all subjects. Aldosterone (ALDO), corticosterone (B), deoxycorticosterone (DOC), progesterone (FROG), 17-hydroxyprogesterone (170HP), 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. (C) 1997 Elsevier Science Ltd.