BACKGROUND & AIMS: OBJECTIVES:Evaluation of the voice results after Wendler glottoplasty in male-to-female transsexuals (MFTs). STUDY DESIGN:Retrospective case series. METHODS:We retrospectively reviewed 31 MFT patients treated with a Wendler glottoplasty technique. The procedure consists of the CO2-laser de-epithelialization of the anterior commissure along with the anterior third of the two vocal folds, the suturing of the two vocal folds with two 3.0 resorbable threads, and next, the application of fibrin sealant to strengthen the stitches. Voice assessment was based mainly on fundamental frequency, frequency range, maximum phonation time, phonation quotient, estimated subglottic pressure (ESGP), grade of dysphonia (G), and voice handicap index. The measurements were performed preoperatively and on the last follow-up visit and compared using IBM SPSS 20 statistical package (IBM Corp, Armonk, NY). The patients have been divided in two groups (group A younger than 40 years and group B of or older than 40 years) for assessing the influence of the age of treatment on the results. RESULTS:Group A included 19 individuals with mean age of 28.6 years (range: 16-39 years) and group B included 12 individuals with mean age of 51.9 years (range: 45-59 years). The mean follow-up period was 9.2 months. Three cases had previously undergone a cricothyroid approximation elsewhere. We found a significant improvement of mean F0 from 135.8 to 206.3Hz in total (P = 0.001) and also in both groups, especially in group A (mean F0-postop = 213.8Hz). The mean frequency range had a tendency to decrease postoperatively, whereas the ESGP was significantly higher in both total sample and group A (P = 0.001, respectively). G was increased postoperatively and presented a statistical significance in group B (P = 0.035). A revision Wendler procedure was necessary for three individuals (9.7%); two of them presented a suture's line breakdown because they did not follow the postoperative recommendations for voice rest and the third one had an insufficient web due to an insufficient estimation of the necessary correction. CONCLUSION:Wendler glottoplasty seems to be an effective technique to feminize the voice in MFTs with better results when performed in younger individuals.

背景与目标：

BACKGROUND & AIMS: INTRODUCTION:Testosterone supplementation in ovariectomized or elderly women may improve their sense of well-being and libido, muscle mass and strength, and bone mineral density. Naturally, androgens may have virilizing effects in women. It is often believed that androgens have deleterious effects on cardiovascular risks. AIM:To obtain an inventory of the effects of administration of testosterone on female biological functions. METHODS:We reviewed here our publications on the effects of high-dose androgen administration to female-to-male transsexuals treated between 1975 and 2004 (N = 712). Annual accrual was at a steady rate of 22-30 persons. Dosages administered were far above those suited for women. MAIN OUTCOME MEASURES:There was special focus on the potential negative effects on cardiovascular risk markers. RESULTS:The standard treatment was administration of testosterone esters, 250 mg/2-3 weeks, parenterally). With this dose, virilizing effects on the skin and clitoris were prominent. Spatial ability improved, while verbal fluency deteriorated. The ovaries developed polycystic characteristics. Adequate dosages of testosterone preserved bone mass in females. Androgens increased kallikreins, such as prostate-specific antigen, in female reproductive tissues. High-dose testosterone administration appeared to increase weight, visceral fat, and hematocrit, decrease high-density lipoprotein cholesterol, increase endothelin-1, increase C-reactive protein, and increase total homocysteine. But blood pressure, insulin sensitivity, fibrinolytic markers, arterial stiffness, and levels of von Willebrand factor, fibrinogen, and interleukin-6 remained largely unchanged. CONCLUSIONS:Our studies demonstrated that, while some markers of cardiovascular risk factors showed a shift to a more negative risk profile, others were not affected. Androgen effects on cardiovascular risk markers are therefore not universally negative, and it is reasonable to assume that the latter effects will not be negative with the much lower doses suited for administration to women.

背景与目标：

BACKGROUND & AIMS: :In 1996, metaidoioplasty was introduced as an alternative to phalloplasty in female-to-male transsexuals. To assess the long-term outcome in 70 consecutive patients (mean follow-up 8 years), we established the characteristics of postoperative events and additional surgical procedures. Metaidoioplasty and primary or secondary scrotoplasty was uneventful in 8 patients. In the other patients, postoperative events included immediate postoperative complications (n = 23), urethral fistulas (n = 26) or strictures (n = 25), or loss (n = 22) or dislocation (n = 34) of testicular prostheses. An average of 2.6 surgical procedures per patient was needed to complete genital confirmation and cope with all events. Additional phalloplasty was performed or scheduled in 17 patients. We conclude that genital reassignment by metaidoioplasty cannot usually be completed in 1 step and that phalloplasty is feasible subsequent to metaidoioplasty. We still consider metaidoioplasty to be a method of choice in selected patients.

背景与目标： : 1996年，在女性对男性变性者中引入了子宫成形术作为阴茎成形术的替代方法。为了评估70例连续患者 (平均随访8年) 的长期结局，我们确定了术后事件和其他手术程序的特征。8例患者的子宫成形术和原发性或继发性阴囊成形术顺利进行。在其他患者中，术后事件包括术后即刻并发症 (n = 23)，尿道瘘 (n = 26) 或狭窄 (n = 25)，或睾丸假体丢失 (n = 22) 或脱位 (n = 34)。每个患者平均需要2.6个手术程序来完成生殖器确认并应对所有事件。在17例患者中进行或计划进行其他阴茎成形术。我们得出的结论是，通过子宫成形术进行的生殖器重新分配通常不能在一个步骤中完成，并且在子宫成形术之后进行阴茎成形术是可行的。我们仍然认为，在选定的患者中，甲碘成形术是一种选择方法。

BACKGROUND & AIMS: :Our aim was to examine the effects of androgen administration on breast tissue histology of female-to-male transsexuals and to study the immunohistochemical expression of three human tissue kallikreins, hK3 (PSA), hK6, and hK10. We studied 23 female-to-male transsexuals who were treated with injectable testosterone for 18-24 months. We also used 10 control female breast tissues. All tissues were fixed in buffered formalin, embedded in paraffin, and examined by hematoxylin-eosin staining and immunohistochemical staining for PSA, hK6, and hK10. Females treated with androgens exhibited similar involutionary changes as those seen in breast of menopausal women, such as marked reduction of glandular tissue, involution of the lobuloalveolar structures, and prominence of fibrous connective tissue, but presence of only small amounts of fat tissue. Fibrocystic lesions were generally not observed. In immunohistochemistry, in control breast tissues, we found moderate to strong cytoplasmic immunoexpression of hK6 and hK10 in the epithelial ductal and lobuloalveolar structures, but myoepithelial cells were negative. Luminal secretions were also positive. In menopausal breast, the immunoexpression of hK6 and hK10 was weaker and focal. No control case showed immunoexpression for PSA. In female-to-male transsexuals, one case showed focal PSA cytoplasmic immunoexpression in the epithelium of moderately involuting lobules. Long-term administration of androgens in female-to-male transsexuals causes marked reduction of glandular tissue and prominence of fibrous connective tissue. These changes are similar to those observed at the end-stage of menopausal mammary involution.

背景与目标： : 我们的目的是检查雄激素给药对女性到男性变性者乳腺组织组织学的影响，并研究三种人类组织激肽蛋白hK3 (PSA)，hK6和hk10的免疫组织化学表达。我们研究了23名接受注射睾丸激素治疗18-24个月的女性对男性变性者。我们还使用了10个对照女性乳腺组织。将所有组织固定在缓冲的福尔马林中，包埋在石蜡中，并通过苏木精-伊红染色和免疫组织化学染色检查PSA，hK6和hk10。用雄激素治疗的女性表现出与更年期女性乳房相似的退化变化，例如腺体组织明显减少，小叶肺泡结构退化和纤维结缔组织突出，但仅存在少量脂肪组织。通常未观察到纤维囊性病变。在免疫组织化学中，在对照乳腺组织中，我们发现上皮导管和小叶肺泡结构中hK6和hK10的中度至强细胞质免疫表达，但肌上皮细胞呈阴性。管腔分泌物也呈阳性。在更年期乳房中，hK6和hK10的免疫表达较弱且局灶性。没有对照病例显示PSA的免疫表达。在女性对男性变性者中，一例在中度消退小叶的上皮中显示局灶性PSA胞质免疫表达。在女性到男性变性者中长期使用雄激素会导致腺体组织明显减少和纤维结缔组织突出。这些变化与更年期乳腺退化末期观察到的变化相似。

BACKGROUND & AIMS: :Hepcidin, a 25-amino acid peptide encoded by the HAMP gene and produced mainly by hepatocytes and macrophages, is a mediator of innate immunity and the central iron-regulatory hormone. Circulating hepcidin controls iron efflux by inducing degradation of the cellular iron exporter ferroportin. HCV infection is associated with hepatic iron overload and elevated serum iron, which correlate with poor antiviral responses. The HCV nonstructural NS5A protein is known to function in multiple aspects of the HCV life cycle, probably exerting its activity in concert with cellular factor(s). In this study, we attempted to delineate the effect of HCV NS5A on HAMP gene expression. We observed that transient transfection of hepatoma cell lines with HCV NS5A resulted in down-regulation of HAMP promoter activity. A similar effect was evident after transduction of Huh7 cells with a recombinant baculovirus vector expressing NS5A protein. We proceeded to construct an NS5A-expressing stable cell line, which also exhibited down-regulation of HAMP gene promoter activity and significant reduction of HAMP mRNA and hepcidin protein levels. Concurrent expression of HCV core protein, a well-characterized hepcidin inducer, revealed antagonism between those two proteins for hepcidin regulation. In attempting to identify the pathways involved in NS5A-driven reduction of hepcidin levels, we ruled out any NS5A-induced alterations in the expression of the well-known hepcidin inducers SMAD4 and STAT3. Further analysis linked the abundance of intracellular zinc ions and the deregulation of the MTF-1/MRE/hepcidin axis with the observed phenomenon. This effect could be associated with distinct phases in HCV life cycle.

背景与目标： : Hepcidin是由HAMP基因编码的25个氨基酸的肽，主要由肝细胞和巨噬细胞产生，是先天免疫和中枢铁调节激素的介质。循环铁调素通过诱导细胞铁输出体铁转运蛋白的降解来控制铁的流出。HCV感染与肝铁超负荷和血清铁升高有关，这与不良的抗病毒反应有关。已知HCV非结构性NS5A蛋白在HCV生命周期的多个方面起作用，可能与细胞因子协同发挥其活性。在这项研究中，我们试图描述HCV NS5A对HAMP基因表达的影响。我们观察到用HCV NS5A瞬时转染肝癌细胞系导致HAMP启动子活性下调。用表达NS5A蛋白的重组杆状病毒载体转导Huh7细胞后，也有类似的作用。我们着手构建NS5A-expressing稳定的细胞系，该细胞系还显示出HAMP基因启动子活性的下调以及HAMP mRNA和hepcidin蛋白水平的显着降低。HCV核心蛋白 (一种特征明确的铁调素诱导剂) 的同时表达揭示了这两种蛋白之间对铁调素调节的拮抗作用。在试图确定NS5A-driven降低铁调素水平的途径时，我们排除了众所周知的铁调素诱导剂SMAD4和stat3表达的任何NS5A-induced改变。进一步的分析将细胞内锌离子的丰度和MTF-1/mri/hepcidin轴的失调与观察到的现象联系起来。这种效应可能与HCV生命周期的不同阶段有关。

BACKGROUND & AIMS: :We devised a technique for phalloplasty in a female-to-male transsexual combining the lateral upper arm free flap with a bladder mucosa graft, to address the ideal requirements of phalloplasty in the best possible way. The surgical techniques are described. Healing of the phallus has been uneventful, but postoperative bladder spasms, meatal stenosis, and an intraurethral valve were encountered. The cosmetic result of the phalloplasty is pleasing. Sensibility is still increasing after a 14-month follow-up. Scarring of the upper arm donor site can be camouflaged easily. Although the actual phalloplasty as described in this article is a one-stage microsurgical procedure that appears to be reproducible, the construction of a phallus meeting all requirements still implies more than one stage.

背景与目标： : 我们设计了一种将上臂外侧游离皮瓣与膀胱粘膜移植物相结合的女性到男性变性者的阴茎成形术技术，以最佳方式解决了阴茎成形术的理想要求。描述了手术技术。阴茎愈合顺利，但术后出现膀胱痉挛，狭窄和尿道内瓣膜。阴茎成形术的美容效果令人愉悦。经过14个月的随访，敏感性仍在增加。容易掩盖上臂供体部位的疤痕。尽管如本文所述的实际阴茎成形术是一种似乎可重复的一阶段显微外科手术，但满足所有要求的阴茎的构造仍意味着不止一个阶段。

BACKGROUND & AIMS: :The purpose of this study was to compare differences of the psychological burdens between young male transsexuals and age-gender matched non-transsexuals with standardized psychiatric rating scales in Korea. A total of 43 biologically unrelated young male transsexuals and 49 age-gender matched non-transsexuals participated in the study. All subjects completed Beck's Depression Inventory (BDI), Social Avoidance and Distress Scale (SADS), Self-Esteem Scale (SES) and Family Adaptability and Cohesion Evaluation Scale (FACES-III). The transsexuals showed significantly higher scores on the BDI (P < 0.0001) and SADS (P = 0.002) and lower scores on the SES (P < 0.0001) and Adaptability and Cohesion subscales (P = 0.016 and P < 0.0001, respectively) of the FACES-III than those of the non-transsexuals. The present study found young male transsexuals may be potentially vulnerable to develop psychiatric and familial problems in comparison with non-transsexuals, at least in Korea, although methodological limitations exist. Further well-designed researches should be launched to confirm this preliminary study.

背景与目标： : 这项研究的目的是比较韩国年轻男性变性人与年龄与性别相匹配的非变性人之间的心理负担差异，并采用标准化的精神病评定量表。共有43名与生物学无关的年轻男性变性者和49名年龄性别匹配的非变性者参加了这项研究。所有受试者均完成贝克抑郁量表 (BDI) 、社会回避与困扰量表 (SADS) 、自尊量表 (SES) 和家庭适应性与凝聚力评价量表 (FACES-III)。变性者在BDI (P < 0.0001) 和SADS (P = 0.002) 上的得分明显较高，在SES (P < 0.0001) 和适应性和凝聚力分量表上的得分较低 (P = 0.016和P <0.0001)，分别) 的脸-III比非变性人的脸。本研究发现，与非变性者相比，年轻的男性变性者可能容易出现精神和家庭问题，至少在韩国是这样，尽管方法上存在局限性。应开展进一步精心设计的研究，以确认这一初步研究。

BACKGROUND & AIMS: :Gender dysphoria is a condition in which a discrepancy between biological sex and gender identity causes distress. Many female-to-male transsexuals (FTMTS) are uncomfortable with female breasts. Chest wall contouring surgery is effective for obtaining a male-type chest, reducing mental stress, and increasing sexual satisfaction in such cases. At the Okayama University Hospital Gender Center, we have obtained positive results using an algorithm to determine the most appropriate surgical method for chest wall contouring in FTMTS patients. However, serious complications requiring reoperation, such as hematoma, may still occur. Postoperative hematomas were found in 15 (4.18%) of 358 FTMTS patients who underwent chest contouring surgery at our hospital between 2006 and 2018. Postoperative hematoma was examined retrospectively. The median time to the onset of hematoma was 7 (6-12) h after the initial surgery. The main blood vessels causing bleeding were those in the head-side skin flap region where visual confirmation was difficult and the perforator vessels from the pectoralis major muscle. Intraoperative bleeding and the operation time had a significant impact on the onset of postoperative hematoma. This is the first retrospective study that investigated the blood vessels and other factors contributing to postoperative hematoma development after chest wall contouring.

背景与目标： : 性别不安是生物性别和性别认同之间的差异导致困扰的一种情况。许多女性变性人 (FTMTS) 对女性乳房不舒服。在这种情况下，胸壁轮廓手术可有效获得男性型胸部，减轻精神压力并提高性满意度。在冈山大学医院性别中心，我们使用一种算法来确定最适合FTMTS患者胸壁轮廓的手术方法，从而获得了积极的结果。但是，仍然可能发生需要再次手术的严重并发症，例如血肿。在我们医院2006年和2018年接受胸部整形手术的358例FTMTS患者中，有15例 (4.18% 例) 发现了术后血肿。回顾性检查术后血肿。初次手术后至血肿发作的中位时间为7 (6-12) 小时。引起出血的主要血管是难以进行视觉确认的头侧皮瓣区域和胸大肌的穿支血管。术中出血和手术时间对术后血肿的发生有显著影响。这是第一个回顾性研究，研究了胸壁轮廓后导致术后血肿发展的血管和其他因素。

BACKGROUND & AIMS: :Prenatal exposure to androgens has been implicated in transsexualism but the etiology of the condition remains unclear. The ratio of the 2nd to the 4th (2D:4D) digit lengths has been suggested to be negatively correlated to prenatal androgen exposure. We wanted to assess differences in 2D:4D ratio between transsexuals and controls. Sixty-three male-to-female transsexuals (MFT), 43 female-to-male transsexuals (FMT), and 65 female and 58 male controls were included in the study. Photo copies of the palms and digits of the hands were taken of all subjects and 2D:4D ratios were measured, according to standard published procedures. Comparison between right-handed individuals revealed that the right-hand 2D:4D in MFT is higher than in control males but similar to that observed in control females. In FMT we found no differences in 2D:4D relative to control females. Our findings support a biological etiology of male-to-female transsexualism, implicating decreased prenatal androgen exposure in MFT. We have found no indication of a role of prenatal hormone exposure in female-to-male transsexualism.

背景与目标： : 产前暴露于雄激素与变性有关，但该病的病因尚不清楚。第2位至第4位 (2D:4D) 位长度的比率已被建议与产前雄激素暴露呈负相关。我们想评估变性者和对照组之间2D:4D比率的差异。该研究包括63名男女变性人 (MFT)，43名男女变性人 (FMT) 以及65名女性和58名男性对照。根据标准发布的程序，对所有受试者进行了手掌和手指的照片副本，并测量了2D:4D比率。右手个体之间的比较显示，MFT的右手2D:4D高于对照组男性，但与对照组女性相似。在FMT中，我们发现2D:4D相对于对照雌性没有差异。我们的发现支持了男女变性的生物学病因，这意味着MFT的产前雄激素暴露减少。我们没有发现产前激素暴露在女性对男性变性中的作用的迹象。

BACKGROUND & AIMS: :The first case of sex reassignment surgery (SRS) in our hospital was performed in January 2001; as of February, 2005, 4 cases of MTF-SRS had been performed. In the 2 most recent cases, we used penile and scrotal skin flaps to avoid complications. The depth and width of the new vagina was made to be adequate for sexual intercourse. Future attention should be focused on devising a surgical technique that will help prevent the complications of partial necrosis of the epidermal skin and wound dehiscence. Although ours is only an initial experience, we describe our surgical technique herein.

背景与目标： : 我们医院的首例变性手术 (SRS) 是在2001年1月进行的; 截至2005年2月，已进行了4例mtf-srs。在最近的2例病例中，我们使用了阴茎和阴囊皮瓣以避免并发症。使新阴道的深度和宽度足以进行性交。未来的注意力应集中在设计一种外科手术技术上，该技术将有助于防止表皮皮肤部分坏死和伤口裂开的并发症。尽管我们只是最初的经验，但我们在此描述了我们的外科手术技术。

BACKGROUND & AIMS: :Mouse strains exhibit different susceptibilities to gamma-ray-induced thymic lymphomas. Our previous study identified Mtf-1 (metal responsive transcription factor-1) as a candidate susceptibility gene, which is involved in the radiation-induced signaling pathway that regulates the cellular reactive oxygen species (ROS). To reveal the mechanism for the increased susceptibility conferred by Mtf-1 locus, we examined early effects of gamma-ray on ROS levels in vivo and its difference between Mtf-1 susceptible and resistant congenic mice. Here, we show the detection of clonally growing thymocytes at 4 weeks after irradiation, indicating the start of clonal expansion at a very early stage. We also show that large thymocytes with higher ROS levels and a proliferation capacity were more numerous in the Mtf-1 susceptible mice than the resistant mice when examined at 7 days after irradiation, although such tendency was not found in mice lacking one allele of Bcl11b tumor suppressor gene. This high retention of the large thymocytes, at a high risk for ROS-induced mutation, is a compensatory proliferation and regeneration response to depletion of the thymocytes after irradiation and the response is likely to augment the development of prelymphoma cells leading to thymic lymphomas.

背景与目标： : 小鼠品系对 γ射线诱导的胸腺淋巴瘤表现出不同的敏感性。我们先前的研究将Mtf-1 (金属响应转录因子-1) 确定为候选易感基因，该基因参与调节细胞活性氧 (ROS) 的辐射诱导信号传导途径。为了揭示Mtf-1基因座赋予敏感性增加的机制，我们研究了伽马射线对体内ROS水平的早期影响及其在Mtf-1易感和抗性同基因小鼠之间的差异。在这里，我们显示了照射后4周检测到克隆生长的胸腺细胞，表明克隆扩增在很早的阶段就开始了。我们还显示，在照射后7天检查时，在Mtf-1易感小鼠中，具有较高ROS水平和增殖能力的大胸腺细胞比抗性小鼠更多，尽管在缺乏Bcl11b肿瘤抑制基因一个等位基因的小鼠中未发现这种趋势。大胸腺细胞的这种高保留，具有ROS诱导的突变的高风险，是对照射后胸腺细胞耗竭的代偿性增殖和再生反应，并且该反应可能会增加导致胸腺淋巴瘤的淋巴瘤前细胞的发育。

BACKGROUND & AIMS: In most imaging detectors, the modulation transfer function (MTF) is regarded as a good parameter to describe spatial resolution. This is undoubtedly valid for visual observation. However, the detectability of a detail is essentially a matter of signal-to-noise ratio, which is not accounted for by the MTF. In x-ray imaging, signal-to-noise ratio in the image is generally limited by incident photons statistics, often larger than readout noises. Therefore, the MTF of the detector applies to both signal and noise, and does not impair the image content. Contrast can easily be restored by image processing without altering the signal-to-noise ratio. However, a number of effects may alter very differently noise and signal(i) If the MTF significantly extends beyond half the sampling frequency, the aliasing introduced by spatial sampling can severely enhance the noise and cancel the benefit of the good signal transfer. This is illustrated by synthetic images which simulate the response of imagers with different MTFs to the same test pattern in the presence of quantum noise. (ii) Parallax and blurring by the x-ray spot size or motion are shown to degrade the transfer properties of signal, but do not affect the quantum noise; they must be treated separately. Contrary to the x-ray converter MTF, parallax directly impacts the detective quantum efficiency (DQE). Finally, it is shown that only the detective quantum efficiency can reliably describe the spatial resolution of an x-ray imaging detector in the presence of noise, parallax and blurring.

背景与目标： 在大多数成像探测器中，调制传递函数 (MTF) 被视为描述空间分辨率的良好参数。这对于视觉观察无疑是有效的。但是，细节的可检测性本质上是信噪比的问题，MTF并未考虑这一点。在x射线成像中，图像中的信噪比通常受入射光子统计信息的限制，通常大于读出噪声。因此，检测器的MTF适用于信号和噪声，并且不会损害图像内容。通过图像处理可以轻松恢复对比度，而无需更改信噪比。然而，许多影响可能会改变非常不同的噪声和信号 (i) 如果MTF显著延伸超过采样频率的一半，则由空间采样引入的混叠会严重增强噪声并抵消良好信号传输的好处。合成图像可以说明这一点，该合成图像模拟了在存在量子噪声的情况下具有不同mtf的成像器对相同测试模式的响应。(ii) x射线光斑大小或运动引起的视差和模糊显示会降低信号的传输特性，但不会影响量子噪声; 它们必须分开处理。与x射线转换器MTF相反，视差直接影响探测量子效率 (DQE)。最后，表明在存在噪声，视差和模糊的情况下，只有侦探量子效率才能可靠地描述x射线成像探测器的空间分辨率。

BACKGROUND & AIMS: :Penile skin inversion is the method of choice for vaginoplasty in male-to-female transsexuals. Rectosigmoid neocolpopoiesis should be considered only when penile skin inversion has become impossible or has not led to functional results. In this paper we describe our technique and the results of colocolpopoiesis in 7 male-to-female transsexuals.

背景与目标： : 阴茎皮肤倒置是男女变性者阴道成形术的首选方法。仅当阴茎皮肤倒置变得不可能或未导致功能结果时，才应考虑直肠乙状结肠新生。在本文中，我们描述了我们的技术以及7名男性对女性变性者的coocolpopooiesis的结果。

BACKGROUND & AIMS: :Patients with gender dysphoria are offered cross-sex hormone therapy and sex reassignment surgery to achieve the transition between the sex assigned at birth and gender identity. According to international guidelines, cross-sex hormone therapy in trans-women should lead to a psychologically and physiologically healthy body with feminized serum hormone levels, resulting in suppression of spermatogenesis. However, in a recently published multi-center study, we discovered a high proportion of patients with male serum hormone levels and qualitatively intact spermatogenesis on the day of sex reassignment surgery. The objective of this study was to review the content of 11 publications that focus on the influence of cross-sex hormone therapy on testicular morphology. These publications were identified based on a PubMed search for the key words transgender/transsexual/gender dysphoria in male-to-female persons, cross-sex hormone therapy, and testicular tissues. Whereas three publications described a marked reduction of the spermatogenic level in all patients examined, eight publications reported inconsistent results. Histological analyses showed highly variable outcomes from qualitatively normal spermatogenesis and undisturbed Leydig/Sertoli cell morphology to full testicular regression with severe cellular damage and hyalinization. Explanations for these heterogeneous findings include insufficient cross-sex hormone therapy regarding dosage or duration. As complete spermatogenesis is associated with virilized serum hormone levels, these patients may face challenges especially after sex reassignment surgery in adjusting to the abruptly established hypogonadal state following removal of the testes. These findings also suggest that contraception should be discussed, and fertility preservation should be offered during/prior to cross-sex hormone therapy. There is a need for more individualized and better-controlled cross-sex hormone therapy and post-treatment regimens. Evidence-based guidelines for attending clinicians need to be established in order to deliver the most appropriate care.

背景与目标： : 为性别不安的患者提供跨性激素治疗和变性手术，以实现出生时分配的性别和性别认同之间的过渡。根据国际指南，跨性别女性的跨性别激素治疗应导致心理和生理健康的身体，其血清激素水平女性化，从而抑制精子发生。然而，在最近发表的一项多中心研究中，我们发现在变性手术当天，男性血清激素水平和质量完整的精子发生的患者比例很高。这项研究的目的是回顾11篇出版物的内容，这些出版物着重于跨性激素疗法对睾丸形态的影响。这些出版物是根据PubMed搜索的关键字在男女之间的跨性别/变性者/性别焦虑症，跨性别激素疗法和睾丸组织中确定的。尽管有三份出版物描述了所有接受检查的患者的生精水平显着降低，但有八份出版物报告了不一致的结果。组织学分析显示，从定性正常的精子发生和不受干扰的Leydig/Sertoli细胞形态到严重的细胞损伤和透明化的睾丸完全消退，结果变化很大。对这些异质性发现的解释包括关于剂量或持续时间的跨性激素治疗不足。由于完全的精子发生与男性化的血清激素水平有关，因此这些患者可能会面临挑战，尤其是在变性手术后，在摘除睾丸后适应突然建立的性腺功能减退状态。这些发现还表明，应讨论避孕措施，并在跨性激素治疗期间/之前提供生育力保护。需要更个体化和更好控制的交叉性激素治疗和治疗后方案。为了提供最适当的护理，需要为主治临床医生建立循证指南。

BACKGROUND & AIMS: :As in laboratory animals, long-term oestrogen treatment in the human male might induce prolactinomas. We here report on PRL levels in 142 male-to-female transsexuals, treated with 100 mg cyproterone acetate and 100 micrograms ethinyloestradiol per day for 6-108 months (median 52). PRL levels varied markedly between individuals. No relation with age and length of treatment period was found. In 42 subjects in whom PRL levels were followed serially, a slight fall was measured after 12-15 months of treatment. Galactorrhoea, present in 10 of 142 subjects, was unrelated to PRL levels. In 34 subjects in whom PRL levels were measured during treatment and 3 weeks after withdrawal, PRL levels fell significantly. Dopamine in doses of 0.1 microgram/kg/min and 1.0 microgram/kg/min was administered to six subjects with PRL levels greater than 1000 mU/l and six subjects with PRL levels less than 500 mU/l. No difference in the percentage decrease of PRL levels was found between these two groups. However, administration of monoiodotyrosine, an inhibitor of central dopamine synthesis, to these two groups, induced a significantly smaller release of PRL (expressed as percentage change) in subjects with PRL greater than 1000 mU/l than in those with PRL less than 500 mU/1 possibly indicating a loss of control of central dopaminergic regulation. These findings suggest that the risk of inducing prolactinomas through cross-gender hormone treatment is likely to be small.

背景与目标： : 与实验动物一样，人类雄性长期雌激素治疗可能会诱发泌乳素瘤。我们在这里报告了142名男女变性者的PRL水平，这些变性者每天用100 mg醋酸环丙孕酮和100微克乙炔雌二醇治疗6-108个月 (中位数为52)。PRL水平在个体之间有明显差异。未发现与年龄和治疗时间的关系。在42名连续跟踪PRL水平的受试者中，治疗12-15个月后测得轻微下降。142名受试者中有10名存在半乳糖，与PRL水平无关。在治疗期间和停药后3周测量PRL水平的34名受试者中，PRL水平显着下降。将0.1微克/kg/min和1.0微克/kg/min的剂量的多巴胺施用于PRL水平大于1000的六名受试者和PRL水平小于500的六名受试者。在这两组之间，PRL水平下降的百分比没有差异。然而，向这两组施用中枢多巴胺合成抑制剂单碘酪氨酸，在PRL大于1000 mU/l的受试者中，PRL的释放明显小于PRL小于500 mU/1的受试者，这可能表明中枢多巴胺能调节的控制丧失。这些发现表明，通过跨性别激素治疗诱发泌乳素瘤的风险可能很小。