Established risk factors for coronary heart disease are unrelated to androgen-induced baldness in female-to-male transsexuals

Abstract

A high scalp sensitivity to androgens is part of the pathophysiology of male-pattern baldness (MPB). Androgens affect established risk factors for coronary heart disease (CHD), and a supposedly heightened impact on these risk factors is hypothesized to explain the epidemiological association between MPB and CHD. In this retrospective, observational study we studied 81 femaleto-male transsexual (F<M) subjects, mean age 36·7 years (range 21-61), treated with testosterone esters (n=61; 250 mg i.m./2 weeks) or testosterone undecanoate (n=20; 160-240 mg/day orally). The degree of MPB was selfassessed using a 5-point scale (i.e. type I (no hair loss) to type V (complete hair loss)). Body mass index, blood pressure and levels of lipid and insulin were retrospectively assessed at the start of testosterone administration (0·5-24 years before) and between 3 and 4 months of follow-up. We found that 31 of 81 (38·3%) F<M transsexuals had MPB type II-V. Thinning of hair was related to the duration of androgen administration and present in about 50% of F<M transsexuals after 13 years. None of the CHD risk factors at follow-up, nor proportional changes, was associated with the degree MPB, except that there was an unexpected tendency of lower fasting glucose levels in balding subjects. Therefore, our findings do not support the idea that MPB serves as an indicator of increased CHD risk through androgenic effects on classic CHD risk factors.

The sudden and unexpected death of a female-to-male transsexual patient

“…4,5 On the other hand, cross-sex hormonal treatment for transsexualism has not changed remarkably during the past 30 years, with female-to-male transsexual patients being administered androgen. 3,[5][6][7][8][9] In the current case, the cadaver obviously showed virilism, such as hirsutism, acne and strong muscles. On microscopic examination, there were no findings in the ovaries indicative of polycystic ovary syndrome (PCOS), which results in amenorrhea, hirsutism, obesity and polycystic ovaries.…”

“…[2][3][4][5][6][7][8] Surgical transformation has greater clinical and economic benefits than cross-sex hormonal treatment for transsexual patients. 4,5 On the other hand, cross-sex hormonal treatment for transsexualism has not changed remarkably during the past 30 years, with female-to-male transsexual patients being administered androgen.…”

Hypertension and aldosterone levels in women with early-onset androgenetic alopecia

“…Giltay et al, 13 in a retrospective, observational study, analysed 81 female-to-male transsexual subjects treated with testosterone esters and 38AE3% developed AGA; however, no differences in BP values were found. Also we have not found a positive correlation between systolic or diastolic BP values and testosterone.…”

Baldness, benign prostate hyperplasia, prostate cancer and androgen levels

“…Once a scalp hair follicle has become sensitive to androgens, it will progressively shrink over the next years [6]. Because most male AA patients have normal circulating androgen levels, a local imbalance of DHT and androgen hypersensitivity in balding versus nonbalding scalps are considered to be one of the pathogenetic factors [7]. Age seems to be a confounding factor in the interpretation of androgenic effects on the hair follicle and prostate.…”