title: Spironolactone with physiological female steroids for presurgical therapy of male-to-female transsexualism.
abstract: The clinical and hormonal response to 12-month therapy with the antiandrogen, spironolactone, in conjunction with near-physiologic doses of female gonadal steroids in 50 transsexual males, is presented. An unselected referred series of 61 men with the psychiatric diagnosis of transsexualism was treated; 10 subjects who had received previous gonadal surgery and 1 man with Klinefelter's syndrome were excluded. Twenty-seven conventionally treated (CT; high-dose estrogen), age 34.4 +/- 10.5 years, mean +/- SD, and 23 untreated patients (SPS), age 30.7 +/- 6.2 years, were studied. Following the initial visit, all 50 were begun on spironolactone and low-dose female hormone therapy. Despite high-dose estrogen treatment for more than 2 years, the mean testosterone (T) level for the CT group was not in the female range (169 +/- 193 ng/dl; normal 20-80). Spironolactone, in doses of 200-600 mg/day, lowered T to the female range in both groups after 12 months (CT 87 +/- 111 and SPS 49 +/- 41 ng/dl). This was achieved in the CT group despite decreases in estrogen dose and discontinuation of parenteral therapy. SPS subjects experienced significant decreases in plasma T (642 +/- 236 to 49 +/- 41 ng/dl, p less than 0.001). Systolic blood pressure dropped (128 +/- 14 to 121 +/- 14 mm Hg, p less than 0.05). The clinical response, including decreased male pattern hair, breast development, feminization, and lack of erections was excellent in most subjects.
authors.affiliation: Department of Medicine (Endocrinology), University of British Columbia, Vancouver General Hospital, Canada.
authors.forename: J C
authors.initials: JC
authors.lastname: Prior
authors.forename: Y M
authors.initials: YM
authors.lastname: Vigna
authors.forename: D
authors.initials: D
authors.lastname: Watson
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D004966:Estrogens, Conjugated (USP) / Q000008:administration & dosage*; D005500:Follow-Up Studies; D012739:Gonadal Steroid Hormones / Q000097:blood; D006801:Humans; D008297:Male; D008525:Medroxyprogesterone / Q000008:administration & dosage / Q000031:analogs & derivatives*; D017258:Medroxyprogesterone Acetate; D012727:Sex Characteristics; D013148:Spironolactone / Q000008:administration & dosage*; D014189:Transsexualism / Q000097:blood / Q000601:surgery*
chemical_list: D004966:Estrogens, Conjugated (USP); D012739:Gonadal Steroid Hormones; D013148:Spironolactone; D017258:Medroxyprogesterone Acetate; D008525:Medroxyprogesterone