Introduction: Gender identity disorder (GID) is a disagreement between biological sexual differentiation and self-declared gender identity. The aetiology of GID remains unclear, although endocrinological, neuroanatomical and psychosocial factors are all thought to be causally involved. Polycystic ovary syndrome (PCOS) is characterized by chronic anovulation, polycystic ovarian morphology, and biochemical and/or biological signs of hyperandrogenism. Most women with PCOS also exhibit insulin resistance and hyperinsulinaemia, which is independent of obesity. Several studies have found a high prevalence of PCOS in FTM patients. In addition, it has been suggested that hyperandrogenism could be related to the development of GID in male transsexuals
Objectives: To determine the prevalence of hyperandrogenism, polycystic ovary syndrome (PCOS) and metabolic syndrome (MS) in female-to-male transsexuals (FMT).
Design and methods: In total, 77 FMT were assessed clinically and biochemically to hyperandrogenism, before the beginning of the treatment with testosterone. We also assessed cardiovascular risk factors and other parameters of MS.
Results: About 26.0% of the sample had overweight, and 19.5% were obese patients. The prevalence of hyperandrogenism was 49.35% and those of PCOS was 36.4%, and 51.9% of patients had MS.
By adjusting the parameters of MS and PCOS, for the body mass index (BMI), we observed that the higher BMI, regardless of the concentrations of free testosterone (FT), increases insulin resistance (HOMA-IR 2.43 vs 2.93 vs 3.85, P<0.001). Of all patients, 27.3% had HDL-cholesterol below 50 mg/dl.
Conclusions: The general hyperandrogenism, and PCOS in particular, are highly prevalent in FMT. The high prevalence of PCOS appears to be related to body weight.
The hyperandrogenism is associated with the development of MS, and other factors such as insulin resistance and decreased HDL-C, which globally increase the cardiovascular risk. These data suggest that gender dysphoria, at least in FMT, could be related to hyperandrogenism.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.
05 - 09 May 2012
European Society of Endocrinology