Using liquid chromatography tandem mass spectrometry to measure steroid hormone profiles in gender dysphoria (GD) patients in a multi-Center setting

Little information is available on cross-sex hormone therapy (CHT) in gender dysphoria (GD) patients on the day of sex-reassignment surgery (SRS). To achieve initial physical adaptation in male-to-female GD patients,... [ view full abstract ]

Little information is available on cross-sex hormone therapy (CHT) in gender dysphoria (GD) patients on the day of sex-reassignment surgery (SRS). To achieve initial physical adaptation in male-to-female GD patients, anti-androgens are usually given in combination with estrogens. Comparing three treatment regimens, it has been recently demonstrated that only continued CHT results in feminized hormone levels on the day of SRS. The effect of CHT on the adrenal and gonadal steroid profile, however, remained unknown.

To assess the effects of three different treatment regimens of CHT until SRS on the adrenal and gonadal steroid profile. [ view full abstract ]

To assess the effects of three different treatment regimens of CHT until SRS on the adrenal and gonadal steroid profile.

Ethical approval was received for this research prior to study initiation and written informed consent was recieved before study participation. The first 15 patients obtained from three independent clinics were selected.... [ view full abstract ]

Ethical approval was received for this research prior to study initiation and written informed consent was recieved before study participation. The first 15 patients obtained from three independent clinics were selected. Patients in clinic A and B discontinued CHT 4-6 weeks and 2 weeks before SRS, whereas patients in clinic C continued treatment. Thirteen steroid hormones were measured by liquid-chromatography - tandem mass spectrometry and were divided into 5 functional axes. Healthy males and females served as controls.

Questionnaires for age, weight, height and intake of medication were collected. Thirteen steroid hormones were evaluated by liquid-chromatography - tandem mass spectrometry, 7 sex hormones by immunofluorometric assays and... [ view full abstract ]

Questionnaires for age, weight, height and intake of medication were collected. Thirteen steroid hormones were evaluated by liquid-chromatography - tandem mass spectrometry, 7 sex hormones by immunofluorometric assays and ELISA and the level of spermatogenesis by the Bergman/Kliesch score.

Mean 11-deoxycorticosterone levels of clinic B (* p < 0.05) were decreased compared to clinic A. Mean 21-deoxycortisol was significantly higher in clinic C compared to clinic B (**** p < 0.00001). Cortisone levels were... [ view full abstract ]

Mean 11-deoxycorticosterone levels of clinic B (* p < 0.05) were decreased compared to clinic A. Mean 21-deoxycortisol was significantly higher in clinic C compared to clinic B (**** p < 0.00001). Cortisone levels were significantly lower in clinic A (* p < 0.05) than in clinic C. Mean androstenedione of clinic A was significantly higher than in clinic C (** p < 0.005). Mean DHEAS of clinic B was significantly lower compared to clinic A (** p < 0.005). Total testosterone was still within male ranges and average testosterone level in clinic A was significantly higher compared to in clinic C (** p < 0.005).

In this first descriptive study examining the adrenal and gonadal hormone profile in GD patients on the day of SRS, we could demonstrate, that CHT had the most marked effect on the sex-steroid axis. Reduced stress hormone... [ view full abstract ]

In this first descriptive study examining the adrenal and gonadal hormone profile in GD patients on the day of SRS, we could demonstrate, that CHT had the most marked effect on the sex-steroid axis. Reduced stress hormone levels were seen in clinic A, indicated by significantly reduced cortisone levels. Best feminized blood serum levels, however, can be achieved if CHT is taken until SRS. These results point to the need for further studies and psychological evaluation on the day of SRS and beyond. Moreover, it demonstrates that more research is needed to improve CHT of GD patients to deliver the best care possible.