Query: Female-to-Male Transsexual

title: Quality of Life Changes in Iranian Patients Undergoing Female to Male Transsexual Surgery: A Prospective Study.
abstract: Gender identity disorder (GID) is associated with various adverse health outcomes as well as psychiatric problems. Quality of life (QOL) in patients after surgery is an important issue, as some cases report dissatisfaction and regret after surgery. The present study compared QOL in female to male (FTM) GID patients before and after gender reassignment surgery (GRS) in an Iranian population. In the present study, 42 natal female patients with Gender Disorder diagnosis, who were referred to the Fertility Research Center of Tehran University of Medical Sciences for GRS from December 2014 to December 2015, were prospectively recruited.  The demographic characteristics, including age, body mass index (BMI) occupational and marital status, educational level, and family support were recorded. Then, participants were asked to complete the Persian version of the 36 Item Short Form Health Survey (SF 36) questionnaire under supervision of the researcher, once at baseline and once 6 months after surgery.  The changes in SF 36 scores and association with the demographic variables were then evaluated using SPSS 16 at significance level of 0.05. Mean age of patients was 34.17 5.58 years with a mean BMI of 43.14 6.91 kg/m2 Most were single (54.8% had primary school education (50.5% and acceptable family support (59.5% Total mean score of QOL significantly improved from 26.43+ 6.81 to 37.52 8.67 (P 0.001) 6 months after surgery and also in all domains (P 0.001) although the increase in emotional problem was not statistically significant (P 0.05) CONCLUSION In conclusion, as the results of the present study highlight, FTM GD patients have a low QOL before surgery that is significantly improved after surgery.

title: Long term hormonal therapy resulting in breast cancer in female to male transsexual
abstract: Testosterone is important for the development of secondary sexual characteristics in female to male transsexuals. On the contrary, it can increase the risk of breast cancer.  We present a rare case of breast cancer in female to male transsexual patient after long term hormonal therapy.  Breast cancer in female to male transsexual patient.  The patient underwent mastectomy and chemotherapy.  The patient had local recurrence of the disease and he underwent re excision, radiotherapy and the tamoxifen treatment. After this treatment, the patient is in the remission from the disease.  Breast cancer in transsexuals appears to be rare. However, there is a potential risk that testosterone exposure can increase the risk of developing breast cancer by the stimulation of breast tissue. There is limited published literature on the risk of breast cancer in transsexual patients.

title: INTERSEX AND GENDER IDENTITY The Pattern of Sexual Interest of Female to Male Transsexual Persons With Gender Identity Disorder Does Not Resemble That of Biological Men An Eye Tracking Study
abstract: Very little has been elucidated about sexual interest in female to male (FtM) transsexual persons.  To investigate the sexual interest of FtM transsexual persons vs that of men using an eye tracking system.  The study included 15 men and 13 FtM transsexual subjects who viewed three sexual videos (clip 1: sexy clothed young woman kissing the region of the male genitals covered by underwear; clip 2: naked actor and actress kissing and touching each other; and clip 3: heterosexual intercourse between a naked actor and actress) in which several regions were designated for eye gaze analysis in each frame. The designation of each region was not visible to the participants.  Visual attentionwasmeasured across each designated region according to gaze duration.  For clip 1, there was a statistically significant sex difference in the viewing pattern between men and FtM transsexual subjects. Longest gaze time was for the eyes of the actress in men, whereas it was for non human regions in FtM transsexual subjects. For clip 2, there also was a statistically significant sex difference. Longest gaze time was for the face of the actress in men, whereas it was for non human regions in FtM transsexual subjects, and there was a significant difference between regions with longest gaze time. The most apparent difference was in the gaze time for the body of the actor: the percentage of time spent gazing at the body of the actor was 8.35% in FtM transsexual subjects, whereas it was only 0.03% in men. For clip 3, there were no statistically significant differences in viewing patterns between men and FtM transsexual subjects, although longest gaze time was for the face of the actress in men, whereas it was for non human regions in FtM transsexual subjects.  We suggest that the characteristics of sexual interest of FtM transsexual persons are not the same as those of biological men. Tsujimura A, Kiuchi H, Soda T, et al. The Pattern of Sexual Interest of Female to Male Transsexual Persons With Gender Identity Disorder Does Not Resemble That of Biological Men: An Eye Tracking Study.

title: Female to Male Transsexual Individuals Demonstrate Different Own Body Identification
abstract: Transsexualism is characterized by feelings of incongruity between one's natal sex and one's gender identity. It is unclear whether transsexual individuals have a body image that is more congruent with their gender identity than their sex assigned at birth (natal sex) and, if so, whether there are contributions from perceptual dysfunctions. We compared 16 pre hormone treatment female to male transsexual (FtM) individuals to 20 heterosexual female and 20 heterosexual male controls on a visual identification task. Participants viewed photographs of their own body that were morphed by different degrees to bodies of other females or males, and were instructed to rate "To what degree is this picture you?" We also tested global vs. local visual processing using the inverted faces task. FtM differed from both control groups in demonstrating higher self identification ratings for bodies morphed to the sex congruent with their gender identity, and across a broad range of morph percentages. This difference was more pronounced for longer viewing durations. FtM showed reduced accuracy for upright faces compared with female controls for short duration stimuli, but no advantage for inverted faces. These results suggest different own body identification in FtM, consisting of a relatively diffuse identification with body images congruent with their gender identity. This is more likely accounted for by conscious, cognitive factors than perceptual differences.

title: Brief Report: Female To Male Transsexual People and Autistic Traits
abstract: The 'extreme male brain' theory suggests females with Autism Spectrum Conditions are hyper masculinized in certain aspects of behavior. We predicted that females with Gender Identity Disorder (who are masculinized) would have elevated Autism Spectrum Quotient (AQ) scores. AQ scores from five groups were compared: (1) n 61 transmen (female to male transsexual people) (2) n 198 transwomen (male to female transsexual people) (3) n 76 typical males; (4) n 98 typical females; and (5) n 125 individuals with Asperger Syndrome (AS) Transmen had a higher mean AQ than typical females, typical males and transwomen, but lower than individuals with AS. Transmen have more autistic traits and may have had difficulty socializing with female peers and thus found it easier to identify with male peer groups.

title: Effects of three different testosterone formulations in female to male transsexual persons.
abstract: Gender dysphoria is characterized by a strong discomfort with the gender assigned at birth and the urge to live as a member of the opposite gender. The acquisition of phenotypic features of the desired gender requires the use of cross sex hormones. Female to male (FtM) transsexual persons are treated with testosterone to induce virilization.  The aim of the study was to assess the effects of three different testosterone formulations on body weight and composition and metabolic and bone parameters.  Forty five FtM transsexuals were randomly assigned to receive testoviron depot (i.m. 100 mg/10 days; n 15) testosterone gel (50 mg/die; n 15) and testosterone undecanoate (i.m. 1,000 mg every 6 weeks for the first 6 weeks and then every 12 weeks, n 15) FtM individuals were studied before, at week 30, and at week 54 of testosterone treatment.  Anthropometric, metabolic, bone, hematological, and biochemical parameters were evaluated at baseline and after 12 months of treatment.  Lean body mass significantly increased and fat mass decreased in all groups. No modifications were reported in fasting insulin and insulin sensitivity index. High density plasma lipoprotein levels declined significantly and low density lipoprotein concentrations increased significantly in the three groups. The activated partial thromboplastin time and factor I did not change while prothrombin time significantly increased in all groups. At week 54, all subjects were amenorrheic and time to amenorrhea did not differ between the three groups. Current general life satisfaction was increased in all subjects after 1 year of treatment.  One year testosterone administration in FtM transsexuals appears to be very safe with no differences among the testosterone formulations used. Our study is preliminary, and the detection of subtle or long term differences in the effects of the three formulations may require further larger and longer term studies in this and other populations.

title: Bone mass, bone geometry, and body composition in female to male transsexual persons after long term cross sex hormonal therapy.
abstract: Female to male transsexual persons (transsexual men) undergo extreme hormonal changes due to ovariectomy and testosterone substitution, allowing studies on sex steroid effects on bone geometry and physiology in the adult.  The objective of the study was to examine the effects of cross gender sex steroid exposure on volumetric bone parameters in transsexual men.  This was a cross sectional study.  Participants were recruited from the Center for Sexology and Gender Problems at the Ghent University Hospital (Ghent, Belgium) PARTICIPANTS Fifty transsexual men after sex reassignment surgery with 50 age matched control women and an additional 16 transsexual men before testosterone substitution and sex reassignment surgery with 16 control women participated in the study.  The main outcome measures were areal and volumetric bone parameters using dual energy X ray absorptiometry and peripheral quantitative computed tomography, body composition (dual energy X ray absorptiometry) sex steroids, markers of bone turnover and grip strength.  Before hormonal treatment, transsexual men had similar body composition and bone geometry as female controls. The transsexual men on long term testosterone therapy, however, demonstrated a higher lean body mass and muscle mass and a greater grip strength as well as a lower body and subcutaneous fat mass and a larger waist and smaller hip circumference compared with female controls (all P 0.001) We observed a larger radial cortical bone size (P 0.001) and lower cortical volumetric bone mineral density at the radius and tibia (P 0.05) in transsexual men on testosterone therapy.  Transsexual men on testosterone substitution therapy present with a different body composition with more muscle mass and strength and less fat mass as well as an altered bone geometry with larger bones compared with female controls.

title: Excessive androgen exposure in female to male transsexual persons of reproductive age induces hyperplasia of the ovarian cortex and stroma but not polycystic ovary morphology.
abstract: Does administration of androgen to female to male transsexual persons (FTMs) of reproductive age induce polycystic ovary (PCO) morphology?  Administration of high dose androgen to women causes pathognomonic changes to the ovarian cortex and stroma that resemble Stein Leventhal syndrome but it does not induce PCO morphology.  Androgen is thought to play a key role in follicular development and to be involved in the pathophysiology of polycystic ovary syndrome (PCOS) In several experimental models, animals given high dose androgen show ovarian changes similar to those in women with PCOS. In previous human studies, the ovaries of FTMs who received androgen for long periods also exhibited PCO morphology.  We conducted a retrospective case control study of women, all without PCOS, undergoing salpingo oophorectomy. The case group consisted of 11 FTMs taking testosterone (duration range: 17 months to 14 years) while the control group consisted of 10 patients with gynaecologic malignancies who did not receive testosterone.  Resected ovaries from both groups were compared histologically with respect to changes in the cortex and stroma, and the number of follicles at each maturation stage. MAIN RESULTS AND THE ROLE OF CHANCE Compared with controls, the FTM group had a thicker ovarian cortex (P 0.0001) and more hyperplastic collagen (P 0.001) ovarian stromal hyperplasia (P 0.003) and stromal luteinization, i.e. luteinized stromal cells with a small dark central nucleus surrounded by clear cytoplasm (P 0.004) Isolated clusters of such stromal luteinized cells were found only in the testosterone treated ovaries of FTMs. The number of primordial follicles was similar in the two groups (P 0.22) The numbers of early stage (primary, pre antral and early antral) follicles, which are dependent on androgen, were also similar (P 0.81) as were the numbers of antral follicles (P 0.97) In contrast, significantly greater numbers of atretic follicles were seen in the FTM than that in the control group (P 0.01) LIMITATIONS, REASON FOR CAUTION In addition to the low numbers in the study groups, the histological changes in FTMs were investigated after testosterone administration, therefore it is possible that some of the observed changes were already present, before androgen administration.  Our results are at variance with those of earlier studies and suggest that excessive androgen exposure in women of reproductive age may not be a factor in the pathogenesis of PCOS.

title: Voice in female to male transsexual persons after long term androgen therapy
abstract: The aim of the present study was to 1) document voice in a large sample of female to male transsexual persons (FMT) 2) compare their vocal characteristics with those of heterosexual biological males, and 3) determine hormonal factors with impact on their fundamental frequency.

title: A very rare case of breast cancer in a female to male transsexual
abstract: The incidence of breast cancer in female to male (FTM) transsexuals who received mastectomy and sex reassignment surgery is very rare. In fact, there is only one previous medical report of such a case. We experienced a case of an FTM transsexual who developed breast cancer 12 years after mastectomy and hysterectomy with bilateral salpingo oophorectomy. Because he had been continuously receiving testosterone during the last 15 years and because histopathological examination revealed positive estrogen receptor and androgen receptor expression, we suggest that exogenous testosterone may have initiated the development of breast cancer via two distinct pathways. We describe the clinical course and condition of the patient and recommend that medical personnel consider the possibility of hormone related cancer in FTM transsexuals receiving cross sex hormones.