Psycho-endocrinological aspects in aging males and transsexual persons
Studies on the relationship between behaviour and sex steroids do not always provide consistent results. The aim of this thesis is to contribute to the clarification of certain endocrinological and psychoendocrinological aspects in two different clinical contexts. More subtle changes in androgen levels in aging males and profound cross-sex hormone administration treatment in transsexual individuals have been considered. Chapter 2 focused on the effects of (inhibiting) oestradiol feedback on gonadotropin and testosterone secretion in young versus elderly men. The hypothesis is tested that decreased T in aging men might result from increased E2 negative feedback. The aim of the study in Chapter 3 was to correlate clinical symptoms tentatively described as ‘andropause’ with biochemical measures of androgen status; the usefulness of questionnaires to detect hypoandrogenism in the elderly being dependent on their ability to predict (subnormal) androgen levels. In the same cohort of elderly men we wished to determine the prevalence of depression as assessed by a 30- item Geriatric Depression Scale (GDS) score and to describe the association between this score and sex steroids, an androgen receptor polymorphism and general health related quality of life and functionality (Chapter 4). In Chapter 5 and 6, we no longer evaluated relative sex hormone deficiencies, but described the effects of drastic induction of overt hypogonadism followed by cross-sex hormonal substitution in transsexual persons.In the first study (Chapter 5) the regulatory role of oestrogens and androgens on haemoglobin and the haematocrit in transsexual persons undergoing cross hormone administration was monitored. To this aim, we assessed a quantitative assay of bone marrow erythropoietic activity, the soluble transferrin receptor. Since the start of treating transsexual persons in the multidisciplinary Ghent Gender Team it has been decided to advise a dual-phase hormonal schedule, with a first reversible part where sex specific features are suppressed together with starting the real life test. In the second phase cross-sex hormones are given resulting in –to a great extent- irreversible feminisation and masculinization. We aimed to describe the Ghent hormonal treatment regimen for the first time, to explain the rationale behind it and to evaluate its long-term safety (Chapter 6).
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