Recovery of hypophyseal-testicular function from sex steroid treatment and the pituitary response to castration in male transsexuals.

Twenty-one male transsexuals who had been on steroid hormone therapy for at least 1 year volunteered for this investigation. Their hormone profiles after stopping sex steroid hormone treatment for periods ranging from 2 to 70 days were examined. Based on their testosterone levels before the sex-reassignment operation which includes castration, penectomy and the construction of an artificial vagina, two separate groups can be distinguished; those with low (group A) and the other with normal (group B) levels. The gonadotrophins levels in group A and group B were (respectively) significantly (P less than 0.05) lower and higher than corresponding levels in a group of normal males. Castration had caused elevations of FSH and LH in both groups. Although the increment rates were different, both groups attained the same maximum levels of FSH and LH. Within each group, the patterns of FSH and LH responses to castration were similar. However, differences in rates and time of significant elevation of FSH and LH were noted. These observations indicate that there is a delay between the cessation of steroid treatment and the recovery of testicular and hypophyseal functions. Testicular function seems to be altered by steroid treatment since excessive secretions of FSH and LH are needed to produce normal testosterone levels. The secretions of FSH and LH are controlled in some ways by the same mechanisms, while they, in other respects, are controlled by different factors.