MadSci Network: Medicine

Re: What happens during a sex transplant?

Date: Tue Jun 10 17:29:56 2003
Posted By: Frederick Sweet, Ph.D., Professor, Ob-Gyn, Washington University School of Medicine, St. Louis MO
Area of science: Medicine
ID: 1055091689.Me

The questions raise many possible medical issues, and they are also not clear about male-to-female or female-to-male sex changes. From the surgical and endocrine (hormone therapy) point of view there are big differences. So I'll have to guess.

First, the very bad news

Indeed, over time, anabolic steroids (AS) such as the male hormone testosterone can enhance athletic performance. Anabolic means: The phase of metabolism in which simple substances are synthesized into the complex materials of living tissue. However, the common trade offs are the adverse side effects which can permanantly injure the athelete's health. Because AS have effects on several organ systems, lots of effects can develop. In general, the orally taken steroids have more adverse effects than parenterally (i.e., injected) administered AS. Also, the type of AS is both important for the athletic performance enhancing effect and also for its adverse effects in particular to the liver (i.e., especially the AS containing a 17-alkyl group have potentially more adverse affects because they take much longer for the body to metabolize and detoxify). One of the problems with athletes, in particular heavy strength athletes and bodybuilders, is the use of oral and parenteral AS at the same time ("stacking"), and in dosages which may be several (up to 40 times) the medically recommended therapeutical dosage. The frequency and severity of side effects is very variable. It depends on several factors such as type of drug, dosage, duration of use and the individual sensitivity and response.

Anabolic Steroids and the Male Reproductive System

AS are derivatives of testosterone, which has strong genitotropic effects (stimulates the growth and develolment of genital tissues). For this reason, it is no surprise that a number of side effects include the reproductive system. The regular use of of anabolic steroids leads to supra-physiological concentrations of testosterone or testosterone derivatives (i.e., way above natural levels in the body). This has an impact on the endocrine system's feed back loop. So then one effect is that the production and release of luteinizing hormone (LH) and follicle stimulation hormone (FSH) is decreased.

Extended use of anabolic steroids in relatively high doses leads to hypogonadotrophic hypogonadism with decreased serum concentrations of LH, FSH, and testosterone.

The following Keywords are related to hypogonadism:

ovarian failure, testicular failure, gonadal failure, eunuchoidism, primary amenorrhea, secondary amenorrhea, decreased sexual function, sparse body hair, sexual dysfunction, decreased muscular strength, and infertility and sexual dysfunction .

Males growing breasts

A well known side effect of AS in males is breast formation (gynecomastia). Gynecomastia is caused by increased levels of circulating estrogens, which are naturally produced sex hormones in females. Estrogens (estradiol and estrone ) are formed in males by conversion of massive amounts of testosterone to estrogens. It is the unnaturally increased levels of circulation estrogens in males that stimulate breast growth. In general, gynecomastia is not reversible.

AS affects sexual drive. Relatively few studies on this issue have been published. But so far it appears that while taking in AS sexual desire is increased, although the frequency of erectile dysfunction is also increased. This may seem contradictory, but sexual appetite is androgen (male hormone) dependent, while erectile function is not. There is also a potential criminal side to overdosing on AS. Because sexual desire and aggressiveness are increased during AS use, the risk of getting involved in sexual assault may also be increased.

Anabolic Steroids and the Female Reproductive System

Small amounts of testosterone are naturally produced in the normal female body just like in the male. But by artificially increasing levels of AS affects the hypothalamic-pituitary-gonadal axis in the brain. These glands at the base of the brain control the timing of ovulation (i.e., the menstrual cycle) and other systems in the body. An increase in circulating androgens will inhibit the production and release of LH and FSH, producing a drop in blood levels of LH, FSH, estrogens and progesterone. This can cause in inhibition of follicle formation, ovulation, and irregularities of the menstrual cycle [in other words, sterility]. These changes are usually more intense in younger women.

Other side effects of anabolic steroid use in females are increased sexual desire and hypertrophy (enlargement) of the clitoris. The few systematic studies that have been done on athletes found that the these effects are similar to the effects in endocrine patients that are treated with anabolic steroids.

Anabolic steroid use by pregnant women can lead to pseudohermaphroditism (ambiguous genitalia) or to growth retardation of the female fetus. Anabolic steroid use may even lead to fetal death.

Getting back to your original questions:

"In the past, atheletes who consumed drugs developed new features and thus opted for a transplant. What are the complications that might occur? Are all the sex organs replaced?"

In my opinion, an athlete opting for a sex change operation because he/she has O.D.-ed on anabolic steroids to enhance his/her athletic performance is like someone burning down his/her house because they had a fire in the kitchen. The anabolic steroids not only make body changes (many of them reversible) but also changes in the central nervous system -- the brain. But once a woman has her uterus, ovaries and breasts removed, and then has her vagina surgically replaced with a kind of penis there's no going back. Similarly, once a surgeon removes a guy's penis and testes and replaces them with a kind of vagina there's no going back. A surgeon cannot possibly recreate something which took nature millions of years to create.
In the case of male athletes who O.D.-ed on anabolic steroids, it is a lot easier and more profitable to undergo breast reduction than to go through an entire sex change operation and complete identity change to boot. Although this kind of surgery has become a big and booming business it is the patient and not the surgeon who must live his/her life out with the consequences.

Now, don't get me wrong. There are certainly circumstances in which quite naturally a person has been struggling with his or her sexual identity. After competent counseling to find out whether or not a sex change operation would improve that person's life by physically establishing a woman's identity for a man the irreversible change can be carried out. Medically, it is considerably more complicated to convert a woman to a man, but it has been done. Once upon a time, Johns Hopkins Medical School formed a Gender Identity Clinic that dealt with the transsexual area of medicine.

Then there was Reed Erickson who was born as Rita Alma Erickson in El Paso, Texas on October 13, 1917. (S)he was from an extremely wealthy family and increased his(her) family fortune after becoming an engineer. After selling much of the business and having undergone sex change procedures, the now Reed Erickson established the Erickson Educational Foundation. The organization can answer many questions dealing with transsexual issues. Unfortunately, Reed Erickson came to a bad end. Before dying in 1992 at the age of 74, (s)he had become addicted to illegal drugs. After the US government had issued drug indictments, Erickson fled to Mexico where he died as a fugitive from the DEA.

Perhaps a better source of information on transsexual matters is The Harry Benjamin International Gender Dysphoria Association. This association was formed to establish Standards of Care for individuals who suffer from Gender Dysphoria -- meaning,
" • • •Ļa psychological state whereby a person demonstrates dissatisfaction with their sex of birth and the sex role, as socially defined, which applies to that sex, and who requests hormonal and surgical sex reassignment. • • • the primary working diagnosis applied to any and all persons requesting surgical and hormonal sex reassignment."

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