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.

Endocrine Treatment of Transsexual People: A Review of Treatment Regimens, Outcomes, and Adverse Effects

“…Indeed, several studies reported lowering of testoster- one with cyproterone acetate 100 g/d (5,23). A synergistic effect with estrogen on the physical and emotional changes was also observed by one group with spironolactone (11). This can be particularly helpful in patients with comorbidities that prohibit high levels of estrogen.…”

“…Addition of progesterone for M3 F transsexual people is advocated by some (8,9,11). Reasons included enhanced breast growth (9,11) or to decrease irritability and breast sensitivity (8).…”

Hormone Therapy in Adults: Suggested Revisions to the Sixth Version of theStandards of Care

“…Of note, the antiandrogen spironolactone is a known antihypertensive agent. One transgender genderspecific study reported a significant reduction of systolic blood pressure when spironolactone was added to the regimen of patients who had been using high-dose estrogen therapy, with a decrease from a baseline of 127.8 mm Hg (SD 13.6) to 120.5 mm Hg after one year (p < 0.05; Prior, Vigna, & Watson, 1989). Studies in nontransgender populations indicate that spironolactone is an effective blood pressure-lowering agent, particularly in refractory hypertension (Lane, Shah, & Beevers, 2007;Ouzan, Catherine, Lincoff, Carr, & Mertes, 2002).…”

“…Antiandrogens have the effect of reducing endogenous testosterone levels or testosterone activity, and thus masculine characteristics, such as body hair. They minimize the dosage of estrogen needed to suppress testosterone, thereby reducing risks associated with high dose exogenous estrogen (Prior, Vigna, Watson, Diewold, & Robinow, 1986;Prior, Vigna & Watson, 1989). Common antiandrogens include:…”

Sexual and Physical Health After Sex Reassignment Surgery

“…In the second part, cross-sex hormones were given, resulting in irreversible feminization and masculinization. In some centers, spironolactone (Prior, Vigna, & Watson, 1989) or cyproterone acetate (van Kesteren, Asscheman, Megens, & Gooren, 1997) are routinely added to estrogen treatment at the beginning of the hormonal treatment, whereas in other centers cross-sex hormonal treatment is started as a unique treatment. No randomized studies are as yet available to determine the optimal dosage of hormones or the preferred regimen for the treatment of transsexuals.…”