We have 600 transsexual patients under our supervision: 450 with F / M transsexualism and 150 with M / F transsexualism.
Earlier opinions were expressed that transsexualism is an endocrine disease associated with excessive secretion of sex hormones of the opposite sex, and therefore attempts were made to treat transsexualism with sex hormones corresponding to the biological sex: estrogen and antiandrogens were used in patients with M / M transsexualism / W-transsexualism – androgens, naturally, to no avail.
Since transsexualism is a congenital disease, in which there is a discrepancy between the differentiation of the external genitalia and the sexual differentiation of the brain, it cannot be excluded that it is based on an enzyme- or prescription-toropathy leading to hormonal imbalances during critical periods of development. The appearance of such a discrepancy is possible due to the fact that differentiation of the external genitalia precedes sexual differentiation of the brain.
Experiments on rats showed that the neonatal effect of androgens leads to the formation of male type of sexual behavior and male type of hormone secretion. In humans, the detection of such hormonal effects presents considerable methodological difficulties. The most suitable for this purpose are patients with congenital dysfunction of the adrenal cortex and persons whose mothers took progestins to save the pregnancy. In both groups, compared to normal control, girls were more likely to exhibit traits of male behavior. However, the gender change in the majority of patients in accordance with the functional and physiological capabilities proceeds quite favorably, which indicates the difficulty in comparing this pathology with transsexualism.
An interesting picture is observed in testicular feminization syndrome. Patients never have doubts about their belonging to the female sex. Testicular feminization syndrome is a disease in which the interaction of androgens and their specific receptors is disrupted and genetic men (46, XU) feel and behave like women.
There are two forms of testicular feminization syndrome: complete and incomplete testicular feminization. And if with full testicular feminization syndrome, patients have the right female physique, then with incomplete feminization is less pronounced, and in some cases signs of masculinization are also detected: rough voice, insufficient development of the mammary glands, hypertrophied clitoris, etc. However, even in patients with incomplete testicular feminization syndrome, there is never any doubt about their belonging to the female sex. This suggests that one of the mechanisms of transsexualism may be the formation of the primary defect of sex hormone receptors or their abnormal expression. Such receptors should be located in the structures of the brain that serve as the morphofunctional basis for the formation of subsequent sexual behavior.
Further perspectives in the study of transsexualism are related to the development and implementation of methods for the study of sex hormone receptors, which will make it possible to judge the functional status of receptors, to determine their number in the cell, affinity, and to study the transport of the hormone into the nucleus.
Since dihydrotestosterone binds to androgen receptors, it is of interest to study the 5-alpha reductase enzyme.
S.Le Vay (1981) found changes in the interstitial nuclei of the anterior hypothalamus in 19 homosexual men.
Other researchers have established the large size of the suprachiasmatic nuclei in two transgender male-female types.
These reports provide the first evidence of a likely connection between organic brain changes and sexual orientation, and also provide grounds for concluding that there is a sex center, which was previously rejected.
We investigated the levels of the following hormones before treatment: luteinizing (LH), follicle-stimulating (FSH), prolactin, cortisol, 17-OPK, testosterone, estradiol. The level of hormones in the blood plasma was determined by enzyme immunoassay with standard antisera in the hormonal laboratory (headed by Prof. N. P. Goncharov) of the Ecological center of the Russian Academy of Medical Sciences.
A hormonal examination showed that in patients with m / w transsexuality, all hormones were within the normal range, however, the testosterone level was at the lower limit of the norm and was significantly lower compared with the healthy control group (p <0.005).
The hormonal examination also showed that, with the exception of testosterone in patients with F / M-transsexualism, all other hormonal parameters (LH, FSH, prolactin, estradiol, cortisol, 17-OPK) were within the age limit of biological sex. Plasma testosterone levels blood in patients with G / M-transsexualism before the start of androgen therapy in the statistical processing of the data obtained (M ± t) was significantly 1.3 times different from the average value determined in healthy women, and amounted to 1.05-3.51 nmol / l with the norm for women is 0.8-2.7 nmol / l. Possible causes of increased testosterone levels in patients with F / M-transsexualism are discussed below.