QUESTION: Affects of testosterone on transitioning men

question / pregunta: 

I'm enrolled in a health class and I've asked my teacher questions about transitioning males and the affects of testosterone on their body, especially considering that estrogen seems to have a protective effect on female bodies. I haven't gotten a straight answer. Particularly, I'm wondering if testosterone makes someone who is transitioning more susceptible to osteoporous and heart disease. It would be great to get this information from a source that has trans people's interests at heart.


Answer posted by:

*Okay, after posting my answer, I saw someone else had answered this, but as a "comment", so it was still listed as "unanswered"... sorry for the same results; I deleted the quotes from abstracts because of this, but I can still send you my search strategy on PubMed if you'd like!

By doing a search in PubMed, I found a review from the Netherlands specifically discussing cardiovascular disease and osteoporosis.
The citation is:

Gooren, L., Giltay, E., Bunck, M. (2008). Long-term treatment of transsexuals with cross-sex hormones: extensive personal experience. Journal of Endrocrinol Metabolism 93(1). Retrieved May 1, 2008, from PubMed database.

I also found a clinical trial, with the citation:

Mueller, A., Kiesewetter, F., Binder, H., Beckmann, M., Dittrich, R. (2007). Long-term administration of testosterone undecanoate every 3 months for testosterone supplementation in female-to-male transsexuals. Journal of Clinical Endocrinol Metabolism 92(9). Retrieved May 1, 2008, from PubMed Database.

I would be more than happy to send you my search strategy and subsequent results if you would like, and if you have access to PubMed. Just so far from glancing, there are probably at least 20 results that would be suited to what you're looking for.

I found a few research

I found a few research studies on the topic:

<1> Gooren LJ. Giltay EJ. Bunck MC. "Long-term treatment of transsexuals with cross-sex hormones: extensive personal experience." Journal of Clinical Endocrinology & Metabolism. 93(1):19-25, 2008 Jan.
CONTEXT: 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. SETTING: The setting was a university hospital serving as the national referral center for The Netherlands (16 million people). PATIENTS: 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. INTERVENTIONS: 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. MAIN OUTCOME MEASURES: 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. [References: 40]

<2> Mueller A. Dittrich R. Binder H. Kuehnel W. Maltaris T. Hoffmann I. Beckmann MW. "High dose estrogen treatment increases bone mineral density in male-to-female transsexuals receiving gonadotropin-releasing hormone agonist in the absence of testosterone." European Journal of Endocrinology. 153(1):107-13, 2005 Jul.
OBJECTIVE: To study the effect of estrogen (E) on the male skeleton in the absence of testosterone (T). DESIGN: Retrospective analyses of 40 middle-aged transsexuals treated with subcutaneous injections of gonadotropin-releasing hormone agonist every 4 weeks and oral 17-beta-estradiol-valerat 6 mg/day over two years until reassignment surgery. METHODS: The bone mineral density (BMD) in the femoral neck and lumbar spine (L2-L4) was measured with dual-energy X-ray absorptiometry at the beginning of cross-sex hormone treatment, after 12 and 24 months, and serum T, E, sex hormone-binding globulin (SHBG), calcitonin (CAL), osteocalcin (OSC), and urinary free deoxypyridinoline (DPD) were measured. RESULTS: After 12 months, a significant increase in BMD in the lumbar spine from 1.2 to 1.234 g/cm2 and after 24 months to 1.274 g/cm2 was observed. There was a significant increase in BMD in the femoral neck area from 1.068 to 1.109 g/cm(2) after 24 months. There was a significant decrease in serum T levels from 18.65 to 0.57 nmol/l after 12 months, and to 0.62 nmol/l after 24 months, a significant increase in SHBG levels from 50.09 to 125 nmol/l after 12 months, and to 130 nmol/l after 24 months, and a significant increase in serum E levels from 73.42 to 881.6 pmol/l after 12 months, and to 923.62 pmol/l after 24 months of cross-sex hormone treatment. Serum levels of CAL, OSC and urinary DPD were unchanged. CONCLUSION: We conclude that high dose E treatment is able to increase BMD significantly in the femoral neck and lumbar spine independently of serum T levels in middle-aged men. There is no risk of osteoporosis developing in male-to-female transsexuals receiving GnRHa when there is an adequate E substitution.

Ruetsche AG. Kneubuehl R. Birkhaeuser MH. Lippuner K. "Cortical and trabecular bone mineral density in transsexuals after long-term cross-sex hormonal treatment: a cross-sectional study." Osteoporosis International. 16(7):791-8, 2005 Jul.
The aim of this study was to explore the effect of long-term cross-sex hormonal treatment on cortical and trabecular bone mineral density and main biochemical parameters of bone metabolism in transsexuals. Twenty-four male-to-female (M-F) transsexuals and 15 female-to-male (F-M) transsexuals treated with either an antiandrogen in combination with an estrogen or parenteral testosterone were included in this cross-sectional study. BMD was measured by DXA at distal tibial diaphysis (TDIA) and epiphysis (TEPI), lumbar spine (LS), total hip (HIP) and subregions, and whole body (WB) and Z-scores determined for both the genetic and the phenotypic gender. Biochemical parameters of bone turnover, insulin-like growth factor-1 (IGF-1) and sex hormone levels were measured in all patients. M-F transsexuals were significantly older, taller and heavier than F-M transsexuals. They were treated by cross-sex hormones during a median of 12.5 years before inclusion. As compared with female age-matched controls, they showed a significantly higher median Z-score at TDIA and WB (1.7+/-1.0 and 1.8+/-1.1, P < 0.01) only. Based on the WHO definition, five (who did not comply with cross-sex hormone therapy) had osteoporosis. F-M transsexuals were treated by cross-sex hormones during a median of 7.6 years. They had significantly higher median Z-scores at TEPI, TDIA and WB compared with female age-matched controls (+0.9+/-0.2 SD, +1.0+/-0.4 SD and +1.4+/-0.3 SD, respectively, P < 0.0001 for all) and reached normal male levels except at TEPI. They had significantly higher testosterone and IGF-1 levels (p < 0.001) than M-F transsexuals. We conclude that in M-F transsexuals, BMD is preserved over a median of 12.5 years under antiandrogen and estrogen combination therapy, while in F-M transsexuals BMD is preserved or, at sites rich in cortical bone, is increased to normal male levels under a median of 7.6 years of androgen treatment in this cross sectional study. IGF-1 could play a role in the mediation of the effect of androgens on bone in F-M transsexuals.

As always, check with a medical health professional for interpretation of these results and how they may apply to you.

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