RATIONALE: Testosterone is important for the development of secondary sexual characteristics in female-to-male transsexuals. On the contrary, it can increase the risk of breast cancer. PATIENT CONCERNS: We present a rare case of breast cancer in female-to-male transsexual patient after long-term hormonal therapy. DIAGNOSIS: Breast cancer in female-to-male transsexual patient. INTERVENTIONS: The patient underwent mastectomy and chemotherapy. OUTCOMES: The patient had local recurrence of the disease and he underwent re-excision, radiotherapy and the tamoxifen treatment. After this treatment, the patient is in the remission from the disease. LESSONS: Breast cancer in transsexuals appears to be rare. However, there is a potential risk that testosterone exposure can increase the risk of developing breast cancer by the stimulation of breast tissue. There is limited published literature on the risk of breast cancer in transsexual patients.
- MeSH
- dlouhodobé vedlejší účinky chemicky indukované MeSH
- hormonální substituční terapie škodlivé účinky MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory prsu chemicky indukované MeSH
- testosteron škodlivé účinky MeSH
- transsexualismus farmakoterapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- Názvy látek
- testosteron MeSH
Hormonal therapy in transsexual patients (TS) includes sexagens administration: androgens in female-to-male transsexual patients (FtM) and oestrogens and antiandrogens in male-to-female transsexual patients (MtF). Duration of hormonal therapy should continue at least 1 year before gender reassignment surgery. Hormonal therapy supresses former gender and induces partially new gender changes. Hormonal therapy continues subsequently after surgery during life. Hormonal therapy in MtF TS includes oestrogens and antiandrogens application. In very young persons in both groups blocking gonadoliberin analogues can be used. In FtM TS testosterone oneself is given (orally and/or parenterally). Authors describe their own experiences with hormonal treatment in 282 TS (163 FtM and 119 MtF). During hormonal therapy statistically significant weight increasing was found in both groups. Total cholesterol increased in FtM. In MtF during hormonal therapy average prolactin level increased from 350.1 to 570.5 mU/l without clinical significance. Total average hormonal therapy duration was 6.73 years in FtM and 4.64 years in MtF and so overall therapy safety assessment is not possible. Any endocrinopathy occurence in the beginning of surveillance was found in 35 persons (12.4 %): simple goiter, autoimmune thyreoiditis, hypothyroidism, hyperthyroidism, gynecomastia, DM type 1, congenital adrenal hyperplasia (CAH), Klinefelter syndrome and nonfunctional pituitary adenoma. It is appropriate as well as in other rare medicine conditions to manage diagnosing and therapy in centers with experience with these issues.
- Klíčová slova
- antiandrogens - female-to-male - hormonal therapy - male-to-female - oestradiol - prolactin - testosterone - transsexualism.,
- MeSH
- hormony terapeutické užití MeSH
- lidé MeSH
- pohlavní dimorfismus MeSH
- postupy změny pohlaví * MeSH
- rozvrh dávkování léků MeSH
- transsexualismus * MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- hormony MeSH
- MeSH
- hormony terapeutické užití MeSH
- lidé MeSH
- postupy změny pohlaví * MeSH
- transsexualismus * MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- komentáře MeSH
- úvodníky MeSH
- Názvy látek
- hormony MeSH
OBJECTIVE: Comparison of duration of surgery, blood loss, complications, lenght of post-operative hospitalisation and post-operative morbidity in a group of patient operated for the diagnosis FtM transsexualism. DESIGN: Retrospective clinical study. MATERIAL: In our set of patients were 163 FtM transsexuals with caryotype 46 XX and normal gynecological finding (81 virgins). They were operated on from 1998-2012 at Department of Obstetrics and Gynecology The First Faculty of Medicine Charles University in Prague and Hospital Na Bulovce after at least of 12 months of hormonal preparation. METHODS: We used following types of hysterectomy and bilateral adnexectomy: total abdominal hysterectomy from infraumbilical median laparotomy (AHL) or from suprapubic transverse incision - Pfannenstiel (AH), laparoscopically assisted vaginal hysterectomy (LAVH), total laparoscopic hysterectomy (TLH). In two patients TLH and colpectomy was performed in one setting. RESULTS: In the 23 AHL group the duration of the surgery was 54 minute, blood loss was 226 ml and the length of post-operative hospitalisation was 6.7 days. In the 22 individualy of AH group the duration of the surgery was 60 minute, blood loss was 240 ml and the length of post-operative hospitalisation was 6.1 days. In 4 patients of LAVH group the duration of the surgery was 73 minute, blood loss 200 ml and the length of post-operative hospitalisation was 5 days. In the TLH group (112 pts) the duration of the surgery was 91 minutes, blood loss was 121 ml and the length of post-operative hospitalisation was 4.4 days. In the 2 TLH with colpectomy group the duration of the surgery was 152 minute, blood loss was 250 ml and the length of post-operative hospitalisation was 5.5 days. In one case a peroperative lesion of urinary bladder occured and once a conversion TLH to AH for a strong vaginal bleeding was necessary. Among postoperative complication in one case subileus in AH group was diagnosed, once vaginal bleeding, once haematoma in the suture and one case of secondary healing. Postoperative complication after TLH included 4 times bleeding from vaginal suture, once haematoma in Douglas pouch, once seroma in the place of trocar insertion, once subileus. Once ureter was injured and treated by the ureteral stent insertion. Complication after AHL and LAVH were not recognised. CONCLUSION: Total laparoscopic hysterectomy is the method of choice in the group of FtM transsexuals. This technique could be used also in nuliparous women with long and narrow vagina. Compared with laparotomic approach lower blood loss and shorter hospital stay was proved. Earlier restitution of full activity is another advantage. Musculus rectus abdominis flap can be used for phallus construction. The only significant disadvantage is a longer duration of surgery.
- MeSH
- délka operace MeSH
- dospělí MeSH
- hysterektomie metody MeSH
- laparoskopie metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- postupy změny pohlaví metody MeSH
- retrospektivní studie MeSH
- těhotenství MeSH
- transsexualismus chirurgie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- randomizované kontrolované studie MeSH
INTRODUCTION: Greater acceptance of sexual minorities has enabled people with transsexualism access to adequate treatment and social integration. Gender reassignment surgery is a complex phase in the care of transsexual patients. In response to a greater volume of patients, surgical techniques have evolved and the outcome in patients with male-to-female transsexualism is now a very accurate imitation of female genitalia, enabling sexual intercourse with orgasm. AIM: To evaluate the results of surgical reassignment of genitalia in male-to-female transsexuals. METHODS: A retrospective 3-month follow-up study of patients' opinions following gender reassignment surgery in 129 patients having a primary procedure (eight of whom had later sigmoideocolpoplasty) and five patients undergoing reoperation following an initial unsuccessful procedure at other units. All patients were male transsexuals. The surgical techniques are described in detail. MAIN OUTCOME MEASURES: Sexual functions and complications 3 months after surgery. RESULTS: All patients were satisfied with the first phase operation. Thirteen patients (9.7%) underwent successful sigmoideocolpoplasty. Main complications were as follows: rectal lesions developing during preparation of the vaginal canal (1.5%); bleeding from the stump of the shortened urethra in the first 48 hours postoperatively requiring secondary suturing (4.5%); temporary urinary retention requiring repeated insertion of urinary catheters for up to 6 days (5.2%); and healing of the suture between the perineum and the posterior aspect of the vaginal introitus healing by secondary intention (5.2%). The neoclitoris had erogenous sensitivity in 93.9% of patients and 65.3% reached orgasm in the first 3 months. CONCLUSIONS: Surgical conversion of the genitalia is a safe and important phase of the treatment of male-to-female transsexuals.
- MeSH
- časové faktory MeSH
- dospělí MeSH
- index tělesné hmotnosti MeSH
- klitoris anatomie a histologie inervace MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlavní orgány chirurgie MeSH
- následné studie MeSH
- pooperační komplikace epidemiologie MeSH
- retrospektivní studie MeSH
- transsexualismus chirurgie MeSH
- vagina anatomie a histologie MeSH
- zákroky plastické chirurgie metody MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
INTRODUCTION: Close relation of nervus dorsalis penis/clitoris and os pubis has a major impact in surgical disciplines. AIM: To summarize a current knowledge about this region, represented by the course of sulcus nervi dorsalis penis/clitoridis. METHODS: Literature search of years 1970-2007. MAIN OUTCOME MEASURES: In male, it accommodates nervus dorsalis penis whereas in female nervus et arteria dorsalis clitoridis. Lateral border of sulcus nervi dorsalis penis corresponds to vertical ridge and lateral border of sulcus nervi dorsalis clitoridis to ventral arc-two parameters, which are parts of the Phenice's method for sexing of isolated os pubis. RESULTS: Exact preparation of nervus dorsalis penis is crucial in correct performance of conversion of genitalia in patients with transsexualism, in reconstruction of posterior urethra, in hypospadia, during performance of penile blockade during circumcision and in revascularization surgery of erectile dysfunction. Possible role of the sulcus nervi dorsalis penis in the Alcock's syndrome is discussed. Similarly, it is advisable to take care of nervus dorsalis clitoridis during reduction clitoridoplasty in patients with adrenogenital syndrome and during the insertion of transobturator vaginal tape. Injury of nervus dorsalis penis/clitoridis leads to hypesthesia or anesthesia of glans penis/clitoridis. The injury to arteria dorsalis clitoridis leads to bleeding and/or hematoma. CONCLUSIONS: Clinical anatomy of sulci is important in several situations in urologic surgery. It is possible to use sulcus nervi dorsalis penis/clitoridis for sexing of isolated pubis for anthropological or forensic purposes.
- MeSH
- analýza určování pohlaví MeSH
- klitoris inervace chirurgie MeSH
- lidé MeSH
- nemoci penisu chirurgie MeSH
- penis inervace chirurgie MeSH
- transsexualismus * MeSH
- úžinové syndromy chirurgie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- přehledy MeSH
AIMS: Objective evaluation of contraction power of the neo-phallus reconstructed with a novel technique in female-to-male transsexuals. PATIENTS AND METHODS: From December 2001 to September 2005, 22 patients with gender identity disorder underwent neo-phalloplasty with the re-innervated latissimus dorsi free flap. All the patients were subjected to an early rehabilitation protocol of the transferred muscle; the beginning time of neo-phallus voluntary contraction was recorded in 18 patients. 14 patients, who came for examinations, were objectively evaluated for the strength of transplanted muscle contraction in neo-phallus by electromyography and measurement of the maximum weight lifted. RESULTS: 18 patients were able to voluntarily contract the neo-phallus after an average period of 4.11 months. In 14 of them, the average weight lifted was 1129 g. After electromyography, the mean number of positive peaks in the 100 ms period was 31.5; the mean amplitude from 10 highest positive peaks, measured peak-to-peak, was 0.99 mV. DISCUSSION AND CONCLUSION: The advantage of this technique is non-requirement of the prosthesis for sexual activity due to the development of strong voluntary contraction of the neo-phallus. Our findings document objectively the strength of voluntary contraction of the neo-phallus as a consequence of re-innervation of the transferred muscle. Furthermore, data represent useful tool for clinical assessment and comparison.
- MeSH
- chirurgické laloky * MeSH
- dospělí MeSH
- kosterní svaly transplantace MeSH
- lidé MeSH
- penis anatomie a histologie fyziologie MeSH
- transsexualismus chirurgie MeSH
- zákroky plastické chirurgie metody MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Twenty two patients with gender dysphoria underwent neo-phalloplasties using a novel technique. Latissimus dorsi musculocutaneus re-innervated free flap was used to allow voluntary rigidity of the neo-penis. From the first 22 patients, 18 have obtained motoric function of reconstructed penis; the "paradox erection" was obtained. 14 patients came for examination after a follow-up period of mean 26.4 months. We evaluated the motility and shape changes of neo-phallus measuring its different size and dimension during relax and muscle contraction. The range of neo-phallus length in relaxed position was between 7 and 17 cm (mean 12.2 cm), its circumference in the same position had a range between 13 and 20 cm (mean 13.7 cm). All patients were able to contract the muscle with an average length reduction of 3.08 cm and an average circumference enlargement of 4 cm. In this study, the dimensions and motility were quantified demonstrating the neo-phallus function and size changes during sexual intercourse.
- MeSH
- chirurgické laloky * MeSH
- koitus fyziologie MeSH
- kosterní svaly transplantace MeSH
- lidé MeSH
- penis anatomie a histologie fyziologie MeSH
- transsexualismus chirurgie MeSH
- zákroky plastické chirurgie metody MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
From December 2001 to September 2005, the technique of total penile reconstruction with a reinnervated free latissimus dorsi myocutaneous flap was used in 22 patients (24-38 years old) with gender dysphoria. These patients were followed up for at least 11 months (range, 11-44 months). All flaps survived. Complications include hematoma (7 cases), vascular thrombosis (2 cases), partial necrosis (1 case), excessive swelling of the neophallus (3 cases), and skin graft loss at the donor site (1 case). Of the 19 patients included in the final evaluation, the transplanted muscle was able to obtain contraction in 18 (95%) cases and 8 patients (42%) had sexual intercourse by contracting the muscle to stiffen and move the neopenis. The described technique of neophalloplasty proved to be a reliable technique and the muscle movement in the neophallus can be expected in almost all cases. The muscle contraction in the neophallus leads to "paradox" erection-stiffening, widening, and shortening of the neopenis, which allows for sexual intercourse in some patients. Subsequent reconstruction of the urethra is possible.
- MeSH
- chirurgické laloky * MeSH
- koitus MeSH
- kosterní svaly transplantace MeSH
- lidé MeSH
- penis fyziologie chirurgie MeSH
- svalová kontrakce MeSH
- transsexualismus chirurgie MeSH
- zákroky plastické chirurgie metody MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Sulcus nervi dorsalis penis/clitoridis is a groove on inferior ramus of pubis and ventral surface of the body of pubis, where dorsal nerve of penis in male and dorsal nerve and artery of clitoris in female run. Close relation of the dorsal nerve of penis/clitoris and pubis, represented by the course of sulcus nervi dorsalis penis/clitoridis has a major impact in surgical disciplines. Exact preparation of the dorsal nerve of penis is crucial in correct performance of conversion of genitalia in patients with transsexualism, in reconstruction of posterior urethra, in hypospadia, during performance of penile blockade during circumcision and in revascularization surgery of erectile dysfunction. The role of sulcus nervi dorsalis penis in the Alcock's syndrome is discussed. Similarly, it is advisable to take care of the dorsal nerve of clitoris inside sulcus nervi dorsalis clitoridis during reduction clitoridoplasty in patients with adrenogenital syndrome and during the insertion of transobturator vaginal tape. Injury of dorsal nerve of penis/clitoridis leads to hypestesia or anestesia of glans penis/clitoridis. The injury of dorsal artery of clitoris leads to hematoma. It is possible to use sulcus nervi dorsalis penis/clitoridis in sexing of isolated pubis from antropological or forensic purposes. Lateral border of sulcus nervi dorsalis penis/clitoridis corresponds to vertical ridge and lateral border of sulcus nervi dorsalis clitoridis to ventral arc--two parameters, which are part of the Phenice's method for sexing of isolated pubis.
