Body Composition and Bone Mineral Density in Male-to-Female Transsexuals During Cross-Sex Hormone Therapy Using Gonadotrophin-Releasing Hormone Agonist

 

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Abstract

Objective: In transsexual people, cross-sex hormone therapy is an important component of medical treatment and results in a complete change in the sex hormone environment. Steroid hormones plays an important role in developing and maintaining bone mass and body composition in both sexes. The aim of this study was to evaluate changes in body composition and bone mineral density (BMD) during cross-sex hormone therapy in transsexuals using gonadotrophin-releasing hormone agonists and intramuscular oestrogens.

Methods: 84 male-to-female transsexuals (MtFs) were treated with 10 mg oestradiol-17β valerate every 10 days. The study population was treated with subcutaneous injections of 3.8 mg goserelin acetate every 4 weeks to suppress endogenous sex hormone secretion completely. Endocrine parameters, body composition and BMD after 12 months and after 24 months were compared with baseline values.

Results: There was a significant decline in gonadotrophins and testosterone, while oestradiol, sex hormone-binding globulin, and high-density lipoprotein levels increased significantly after 12 and 24 months. There was a significant increase in body mass index (BMI), fat mass, and lumbar spine bone mineral density in MtFs during the study period, while lean mass decreased significantly and no effect was observed on femoral bone mineral density.

Conclusion: There was an increase in BMI associated with a shift from lean mass to fat mass. There appears to be no risk of osteoporosis developing in MtFs when there is adequate oestrogen substitution, even in the absence of testosterone. Furthermore in comparison with hormone regimes using oral medications, the complication rates appear to be lower in patients receiving gonadotrophin-releasing hormone agonists and intramuscular oestrogens.

References

• 1 Aedo AR, Landgren BM, Diczfalusy E. Pharmacokinetics and biotransformation of orally administered oestrone sulphate and oestradiol valerate in postmenopausal women.  Maturitas. 1990;  12 333-343
  Search in Google Scholar
• 2 Asscheman H, Gooren L, Assies J. et al . Prolactin levels and pituitary enlargement in hormone-treated male to female transsexual people.  Clin Endocrinol (Oxf). 1988;  28 583-588
  Search in Google Scholar
• 3 Asscheman H, Gooren L, Eklund P. Mortality and morbidity in transsexual patients with cross-gender hormone treatment.  Metabolism. 1989;  38 869-873
  Search in Google Scholar
• 4 Brown MA, Haughton MA, Grant SF. et al . Genetic control of bone density and turnover: role of the collagen 1alpha1, estrogen receptor, and vitamin D receptor genes.  J Bone Miner Res. 2001;  16 758-764
  Search in Google Scholar
• 5 Center JR, Nguyen TV, Sambrook PN. et al . Hormonal and biochemical parameters in the determination of osteoporosis in elderly men.  J Clin Endocrinol Metab. 1999;  84 3626-3635
  Search in Google Scholar
• 6 Cupisti S, Dittrich R, Binder H. et al . Influence of body mass index on calculated androgen parameters in adult women with hirsutism and PCOS.  Exp Clin Endocrinol Diabetes. 2007;  115 380-386
  Search in Google Scholar
• 7 Cupisti S, Kajaia N, Dittrich R. et al . Body mass index and ovarian function are associated with endocrine and metabolic abnormalities in women with hyperandrogenic syndrome.  Eur J Endocrinol. 2008;  158 711-719
  Search in Google Scholar
• 8 Dittrich R, Binder H, Cupisti S. et al . Endocrine treatment of male-to-female transsexuals using gonadotropin-releasing hormone agonist.  Exp Clin Endocrinol Diabetes. 2005;  113 586-592
  Search in Google Scholar
• 9 Elbers JM, Asscheman H, Seidell JC. et al . Effects of sex steroid hormones on regional fat depots as assessed by magnetic resonance imaging in transsexuals.  Am J Physiol. 1999;  276 E317-E325
  Search in Google Scholar
• 10 Falch JA. The effect of physical activity on the skeleton.  Scand J Soc Med Suppl. 1982;  29 55-58
  Search in Google Scholar
• 11 Futterweit W. Endocrine management of transsexual. Hormonal profiles of serum prolactin, testosterone, and estradiol.  N Y State J Med. 1980;  80 1260-1264
  Search in Google Scholar
• 12 Gooren L. Hormone treatment of the adult transsexual patient.  Horm Res. 2005;  64 (S 02) 31-36
  Search in Google Scholar
• 13 Gooren LJ. Olympic sports and transsexuals.  Asian J Androl. 2008;  10 427-432
  Search in Google Scholar
• 14 Gooren L, Assies J, Asscheman H. et al . Estrogen-induced prolactinoma in a man.  J Clin Endocrinol Metab. 1988;  66 444-446
  Search in Google Scholar
• 15 Gooren LJ, Giltay EJ, Bunck MC. Long-term treatment of transsexuals with cross-sex hormones: extensive personal experience.  J Clin Endocrinol Metab. 2008;  93 19-25
  Search in Google Scholar
• 16 Greendale GA, Edelstein S, Barrett-Connor E. Endogenous sex steroids and bone mineral density in older women and men: the Rancho Bernardo Study.  J Bone Miner Res. 1997;  12 1833-1843
  Search in Google Scholar
• 17 Guéguen R, Jouanny P, Guillemin F. et al . Segregation analysis and variance components analysis of bone mineral density in healthy families.  J Bone Miner Res. 1995;  10 2017-2022
  Search in Google Scholar
• 18 Hamburger C. Endocrine treatment of male and female transsexualism. In: Green R, Money J, (eds) Transsexualism and Sex Reassignment. Baltimore: Johns Hopkins Press; 1969: 291-307
  Search in Google Scholar
• 19 Haraldsen IR, Haug E, Falch J. et al . Cross-sex pattern of bone mineral density in early onset gender identity disorder.  Horm Behav. 2007;  52 334-433
  Search in Google Scholar
• 20 Hembree WC, Cohen-Kettenis P, Delemarre-van de Waal HA. et al . Endocrine Society. Endocrine treatment of transsexual persons: an Endocrine Society clinical practice guideline.  J Clin Endocrinol Metab. 2009;  94 3132-3154
  Search in Google Scholar
• 21 Kajaia N, Binder H, Dittrich R. et al . Low sex hormone-binding globulin as a predictive marker for insulin resistance in women with hyperandrogenic syndrome.  Eur J Endocrinol. 2007;  157 499-507
  Search in Google Scholar
• 22 Khosla S, Melton 3rd LJ, Atkinson EJ. et al . Relationship of serum sex steroid levels and bone turnover markers with bone mineral density in men and women: a key role for bioavailable estrogen.  J Clin Endocrinol Metab. 1998;  83 2266-2274
  Search in Google Scholar
• 23 Kronawitter D, Gooren LJ, Zollver H. et al . Effects of transdermal testosterone or oral dydrogesterone on hypoactive sexual desire disorder in transsexual women: results of a pilot study.  Eur J Endocrinol. 2009;  161 363-368
  Search in Google Scholar
• 24 Kuhl H. Pharmacology of estradiol and estriol.  Menopause Rev. 2000;  5 23-44
  Search in Google Scholar
• 25 Lapauw B, Taes Y, Simoens S. et al . Body composition, volumetric and areal bone parameters in male-to-female transsexual persons.  Bone. 2008;  43 1016-1021
  Search in Google Scholar
• 26 Lewiecki EM. Premenopausal bone health assessment.  Curr Rheumatol Rep. 2005;  7 46-52
  Search in Google Scholar
• 27 Michel A, Mormont C, Legros J. A psycho-endocrinological overview of transsexualism.  Eur J Endocrinol. 2001;  145 365-376
  Search in Google Scholar
• 28 Moore E, Wisniewski A, Dobs A. Endocrine treatment of transsexual people: a review of treatment regimens, outcomes, and adverse effects.  J Clin Endocrinol Metab. 2003;  88 3467-3473
  Search in Google Scholar
• 29 Mueller A, Dittrich R, Binder H. et al . High dose estrogen treatment increases bone mineral density in male-to-female transsexuals receiving gonadotropin-releasing hormone agonist in the absence of testosterone.  Eur J Endocrinol. 2005;  153 107-113
  Search in Google Scholar
• 30 Mueller A, Binder H, Cupisti S. et al . Effects on the male endocrine system of long-term treatment with gonadotropin-releasing hormone agonists and estrogens in male-to-female transsexuals.  Horm Metab Res. 2006;  38 183-187
  Search in Google Scholar
• 31 Mueller A, Kiesewetter F, Binder H. et al . Long-term administration of testosterone undecanoate every 3 months for testosterone supplementation in female-to-male transsexuals.  J Clin Endocrinol Metab. 2007;  92 3470-3475
  Search in Google Scholar
• 32 Mueller A, Gooren LJ, Naton-Schötz S. et al . Prevalence of polycystic ovary syndrome (PCOS) and hyperandrogenemia in female-to-male transsexuals.  J Clin Endocrinol Metab. 2008;  93 1408-1411
  Search in Google Scholar
• 33 Orwoll ES, Klein RF. Osteoporosis in men.  Endocrine Rev. 1995;  16 87-117
  Search in Google Scholar
• 34 Reutrakul S, Ongphiphadhanakul B, Piaseu N. et al . The effects of oestrogen exposure on bone mass in male to female transsexuals.  Clin Endocrinol (Oxf). 1998;  49 811-814
  Search in Google Scholar
• 35 Ruetsche AG, Kneubuehl R, Birkhaeuser MH. et al . Cortical and trabecular bone mineral density in transsexuals after long-term cross-sex hormonal treatment: a cross-sectional study.  Osteoporos Int. 2005;  16 791-798
  Search in Google Scholar
• 36 Schlatterer K, Auer DP, Yassouridis A. et al . Transsexualism and osteoporosis.  Exp Clin Endocrinol Diabetes. 1998;  106 365-368
  Search in Google Scholar
• 37 Slemenda CW, Longcope C, Zhou L. et al . Sex steroids and bone mass in older men. Positive associations with serum estrogens and negative associations with androgens.  J Clin Invest. 1997;  100 1755-1759
  Search in Google Scholar
• 38 Stoch SA, Parker RA, Chen L. et al . Bone loss in men with prostate cancer treated with gonadotropin-releasing hormone agonists.  J Clin Endocrinol Metab. 2001;  86 2787-2791
  Search in Google Scholar
• 39 The World Professional Association for Transgender Health . http://www.wpath.org/publications_standards.cfm
• 40 T'sjoen G, Weyers S, Taes Y. et al . Prevalence of low bone mass in relation to estrogen treatment and body composition in male-to-female transsexual persons.  J Clin Densitom. 2009;  12 306-313
  Search in Google Scholar
• 41 Vanderschueren D, Venken, Ophoff J. et al Sex steroids and the periosteum – reconsidering the roles of androgens and estrogens in periosteal expansions.  J Clin Endocrinol Metab. 2006;  91 378-382
  Search in Google Scholar
• 42 Van Kesteren P, Lips P, Deville W. et al . The effect of 1-year cross-sex hormonal treatment on bone metabolism and serum insulin-like growth factor-1 in transsexuals.  J Clin Endocrinol Metab. 1996;  81 2227-2232
  Search in Google Scholar
• 43 Van Kesteren P, Asscheman H, Megens J. et al . Mortality and morbidity in transsexual subjects treated with cross-sex hormones.  Clin Endocrinol (Oxf). 1997;  47 337-342
  Search in Google Scholar
• 44 Van Kesteren P, Lips P, Gooren LJ. et al . Long-term follow-up of bone mineral density and bone metabolism in transsexuals treated with cross-sex hormones.  Clin Endocrinol (Oxf). 1998;  48 347-354
  Search in Google Scholar

Correspondence

Dr. A. Mueller

Department of Obstetrics and

Gynaecology

Erlangen University Hospital

Universitätsstraße 21–23

91054 Erlangen

Germany

Phone: +49/9131/8533 553

Fax: +49/9131/8533 552

Email: andreas.mueller@uk-erlangen.de