Testicular function in transsexual men

Endocrine disorders in men infected with human immunodeficiency virus

Gonadal, adrenal, and thyroid functions were evaluated in 70 men seropositive for human immunodeficiency virus (HIV) infection, clinically categorized as asymptomatic (n = 19), AIDS-related complex (ARC) (n = 9), or acquired immunodeficiency syndrome (AIDS) (n = 42). Twenty of 40 men (50 percent) with AIDS were hypogonadal. Mean serum testosterone concentrations in both ARC (292 +/- 70 ng/dl) and AIDS (401 +/- 30 ng/dl) men were significantly less than in asymptomatic (567 +/- 49 ng/dl) or normal men (608 +/- 121 ng/dl). Of these hypogonadal men, 18 of 24 (75 percent) had hypogonadotropic hypogonadism. Seven of eight hypogonadal men (88 percent) had a normal gonadotropin response to gonadotropin-releasing hormone administration. Hypogonadism correlated with lymphocyte depletion and weight loss. Adrenal cortisol reserve, evaluated by adrenocorticotropin stimulation, was normal in 36 of 39 patients (92 percent) with AIDS. Indices of thyroid function were normal with the exception of one ARC man with a low free thyroxine index. In conclusion, hypogonadism is common in men with HIV infection and may be the first or most sensitive endocrine abnormality.

Changes in gonadotropin regulation in both behavioral and phenotypic disturbances of sexual differentiation in men

Determinations of gonadotropins and testosterone were performed in 22 men with hypospadias (H), seven male-to-female transsexuals (T) and in 16 normal men (N), all of similar age. The response of serum FSH and LH to GnRH was determined in six subjects in each group. Oligospermia was found in five of 13 patients with H. All patients with transsexualism revealed normospermia. Both the patients with H and with T had significantly higher mean serum concentrations of LH than the normals (H: 16.96 +/- 13.83 mIU/ml; T: 15.30 +/- 6.50 mIU/ml; vs 5.73 +/- 3.66 mIU/ml in N). Also, an exaggerated response of LH to GnRH was found in both H and T. No negative correlations were demonstrated between serum LH and testosterone in either the H or the T. Rather, higher mean serum LH occurred together with higher mean serum testosterone in severe H. A significant elevation of basal serum FSH was found in H (H: 7.24 +/- 2.14 mIU/ml vs N: 4.84 +/- 1.65 mIU/ml), which might be related to underlying gonadal injury. No increase of serum basal FSH concentration was found in T patients, but the FSH response to GnRH was higher than in N. It is concluded that hypospadias, a phenotypic disturbance of sexual differentiation, represents a less-specific change in the gonadotropin regulation, while male transsexualism reveals hypergonadotropism with a specifically increased evocability of gonadotropins not coexisting with signs of gonadal injury.

The 24-hour secretory pattern of LH and the response to LHRH in transsexual men

Ten separate aspects of hypothalamic and pituitary function were studied in 13 male-to-female transsexuals and compared to the results of 7 heterosexual adult men. In 4 of 5 transsexuals, the 24-hour mean serum concentration of LH, the LH pulse frequency or amplitude, or the apparent half-life of disappearance of serum LH were greater than the 95% confidence limit of normal men. The maximum concentration of LH or FSH following the administration of 100 micrograms LHRH, the area under the response curve of LH or FSH following LHRH, or both were significantly greater than normal in 5 of 13 male-to-female transsexuals. The response of LH following the administration of LHRH was repeated in 3 subjects during estrogen therapy, and in one there was a paradoxical increase in the response of LH. Transsexualism may be associated with a neuroendocrine defect in the hypothalamus or pituitary that is characterized by high-frequency, high-amplitude pulsatile secretion of pituitary LH.