title: Long-term treatment of transsexuals with cross-sex hormones: extensive personal experience.
abstract: BACKGROUND
  Transsexuals receive cross-sex hormone treatment. Its short-term use appears reasonably safe. Little is known about its long-term use. This report offers some perspectives.
  
  
  METHODS
  The setting was a university hospital serving as the national referral center for The Netherlands (16 million people).
  
  
  METHODS
  From the start of the gender clinic in 1975 up to 2006, 2236 male-to-female and 876 female-to-male transsexuals have received cross-sex hormone treatment. In principle, subjects are followed up lifelong.
  
  
  METHODS
  Male-to-female transsexuals receive treatment with the antiandrogen cyproterone acetate 100 mg/d plus estrogens (previously 100 microg ethinyl estradiol, now 2-4 mg oral estradiol valerate/d or 100 microg transdermal estradiol/d). Female-to-male transsexuals receive parenteral testosterone esters 250 mg/2 wk. After 18-36 months, surgical sex reassignment including gonadectomy follows, inducing a profound hypogonadal state.
  
  
  METHODS
  Outcome measures included morbidity and mortality data and data assessing risks of osteoporosis and cardiovascular disease.
  
  
  RESULTS
  Mortality was not higher than in a comparison group. Regarding morbidity, with ethinyl estradiol, there was a 6-8% incidence of venous thrombosis, which is no longer the case with use of other types of estrogens. Continuous use of cross-sex hormones is required to prevent osteoporosis. Androgen deprivation plus an estrogen milieu in male-to-female transsexuals has a larger deleterious effect on cardiovascular risk factors than inducing an androgenic milieu in female-to-male transsexuals, but there is so far no elevated cardiovascular morbidity/mortality. Low numbers of endocrine-related cancers have been observed in male-to-female transsexuals.
  
  
  CONCLUSIONS
  Cross-sex hormone treatment of transsexuals seems acceptably safe over the short and medium term, but solid clinical data are lacking.
authors.affiliation: Department of Endocrinology, Vrije Universiteit University Medical Center, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands. ljgooren@truemail.co.th
authors.forename: Louis J
authors.initials: LJ
authors.lastname: Gooren
authors.forename: Erik J
authors.initials: EJ
authors.lastname: Giltay
authors.forename: Mathijs C
authors.initials: MC
authors.lastname: Bunck
mesh_terms: D000726:Androgen Antagonists / Q000008:administration & dosage* / Q000009:adverse effects; D002318:Cardiovascular Diseases / Q000139:chemically induced; D017373:Cyproterone Acetate / Q000008:administration & dosage* / Q000009:adverse effects; D004958:Estradiol / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D005260:Female; D006801:Humans; D008297:Male; D010024:Osteoporosis / Q000139:chemically induced; D013739:Testosterone / Q000008:administration & dosage* / Q000009:adverse effects; D014189:Transsexualism / Q000188:drug therapy*
chemical_list: D000726:Androgen Antagonists; D013739:Testosterone; D017373:Cyproterone Acetate; D004958:Estradiol