We observed 450 patients with F / M-transsexualism. A complete hormonal examination was performed in 50 patients. All patients received androgen therapy for a period of 1 month. up to 4 years and were divided into two groups: Group 1 – patients who had not undergone a surgical sex change; Group 2 – patients with surgical sex change or at various stages. It should be noted that the 2nd group was heterogeneous and in turn was divided into two subgroups: patients who underwent unilateral oophorectomy, and patients with bilateral oophorectomy.
All patients received the prolonged drug Sustanon-250, which was administered in a dose of 1 mg intramuscularly 1 time in 2-5 weeks.
The effect of the introduction of androgens began to appear after 2-3 weeks. after the 1st injection of the drug: the libido increased significantly, physical activity increased, the coarsening of the voice occurred, and hair growth began to appear on the upper lip.
Termination of menstrual function occurred in the period from 1 to 6 months. (60% – after the 1st injection, 20% – after the 5-6th injection), although with a properly selected dose, menstruation should stop after the 1st injection.
In 8 patients after 6 months. after the start of therapy, we observed clitoris hypertrophy up to 4-5 cm.
One year after the onset of androgen administration, all patients with F / M transsexualism showed good virilizing and masculinizing effects: an increase in muscle mass, hair growth on the face and body, an increase in leg size (this is due to the anabolic effect of androgens on muscle tissue). A number of patients have a significant decrease in the mammary glands, which allows them to continue to do without mastectomy.
It was noted that there are no differences in the dose of the resulting product, which is reflected in the preservation of the individual period of administration of the drug (all patients receive 1 ml containing 1 mg of active substances in the form of testosterone esters) before and after reconstructive surgery, i.e. Both ovaries do not alter the sensitivity of the receptors to the andenogens, which is explained by the fact that the introduction of androgens even before the operation “turns off” the ovarian function.
In 2 patients who underwent bilateral oophorectomy, we observed the development of a severe post-attritional syndrome, difficult to treat, which was accompanied by weakness, headache, swelling, decreased mood, sensations of fever, chills and interruptions in the heart, fluctuations in blood pressure. It should be noted that in these patients androgen therapy was not carried out before the operation, and its appointment after the operation, already with the development of severe symptoms of the post-attritional syndrome, did not allow the patients to fully normalize.
In this regard, we recommend starting androgen therapy before surgical reconstructive surgery, including oophorectomy, as well as to remove only one ovary in order to avoid the development of severe post-castration syndrome.
The weight factor of the adverse postoperative course is the age of the patients. So, in 2 patients (38 and 42 years) for 5-6 months. after hysterectomy and one-sided oophorectomy, despite the ongoing treatment with androgens (1 injection in 3 weeks, testosterone level after 3 weeks. 12-14 nmol / l, which corresponds to the lower limit of the norm for men), we observed a clinical picture similar to the post-hart syndrome .
Thus, the treatment of F / M transsexualism, both hormonal and surgical, should be started as early as possible.
In 30 patients with F / M-transsexualism who are on androgen therapy, we determined the change in the blood level of testosterone after a single injection of 1 ml of Sustanon-250 for 4 weeks. In 80% of cases, a decrease in testosterone level was observed after 3.5 weeks, in 3 patients 14 days after injection
I ml Sustanon testosterone levels were lower
II nmol / l (at the normal for men 13-33 nmol / l), which was accompanied by weakness, increased fatigue, decreased mood and physical activity. These patients were recommended the introduction of the drug 1 time in 2 weeks. In 3 patients, testosterone levels below normal levels decreased only by the end of the 5th week, afterwards they were recommended to inject the drug 1 time in 5 weeks. to reduce the risk of side effects associated with overdose of the drug. The most frequent side effect associated with an overdose of the drug is acne on the face, back.
Thus, this observation shows the need for an individual approach to the appointment of hormone therapy, which should be selected under the control of testosterone levels in the blood plasma.