A 45-year-old male to female transsexual presented with poor female fat distribution. She had been treated with oestrogen for 13 years, initially as ethinyl oestradiol to a maximum dose of 150 ug/day, presently taking 100 mcg with GNRH analogue. On this regimen she had B cup breast development but underwent breast augmentation surgery and still suffered from low self-esteem. She was dissatisfied with her body image because she perceived a male body fat distribution. Her initial assessment revealed BMI of 26 kg/m2, central adiposity with waist measurement of 100 cm, hip measurement of 105 cm.
She was commenced on rosiglitazone 2 mg/day and after 14 months of therapy her waist size dropped to 82.5 cms and hip measurement to 94.5 cms and at this point, her right and left thigh measurements were 45×44 cms respectively. Another 6 months of treatment on Rosiglitazone lead to drop in waist & hip measurement to 82×93 cms respectively and an increase in right and left thigh measurements to 49×47 cms respectively, which gave her a more desirable body image.
Dissatisfaction with body image can be devastating to the psychological well being of a transsexual individual. Cosmetic surgical procedures like liposuction are invasive, not cost effective or free of complications and may not necessarily prove to be a long-term solution for an individual and therefore medical therapy with thiazolindinediones may have a place as therapy in achieving body shape change. Thiazolindinediones are known to have effects on fat metabolism and body fat redistribution and can shift fat form central adipose stores to the subcutaneous tissue, and therefore rosiglitazone was tried in this case.
This is the first report of the use of thiozolidinediones to enhance a female fat distribution in a male to female transsexual on oestrogen treatment.