Dedicated to the acceptance, medical treatment, & legal protection of individuals in the process of correcting the misalignment of their anatomical sex, & supporting their transition into society.
is a birth condition that misaligns innate neurobiological makeup and external genitalia.
An increasing number of patients and commentators view HBS as a more precise term than transsexual, more loosely applied to include those who present with limited hormone usage and/or alternative social presentation.
TS-Si.org articles may use the traditional terminology. If so, we annotate the context and usage as warranted to resolve any ambiguities that could affect interpretation.
Blood plasma is the liquid component of blood, comprising about 55% of total blood volume.
Plasma is mostly water (90% by volume) and contains the actual blood cells, along with dissolved proteins, glucose, hormones, mineral ions, and carbon dioxide. Plasma is the main medium for transporting excretory products.
Technicians prepare blood plasma by spinning a tube of fresh blood in a centrifuge until the blood cells migrate to the bottom of the tube. The blood plasma is then poured or drawn off for use or further processing.
Plasmapheresis is the separation of plasma from red blood cells. It also is a type of medical therapy that involves separation of plasma from red blood cells.
Blood serum is blood plasma without clotting factors, such as fibrinogen, a soluble plasma glycoprotein that is synthesised by the liver.
HBS Patients And Research
Men and women with a history of Harry Benjamin Syndrome (HBS) are a unique — but virtually unutilized — resource for research studies. Men with HBS histories are unencumbered with long-term exposure to testosterone prior to transition. HBS women do not have menstrual histories and are non-menopausal.
Both HBS men and women exhibit the measurable consequences of hormone therapy (HT) and related medication.
Even though women with a history of Harry Benjamin Syndrome (HBS) have never been through menopause, doctors, endocrinologists and other medical practioners still use traditional practice and deny the appropriate types of estrogen and sufficient dosages to their M2F patients when prescribing hormones.
This practice derives from studies of women who have been prescribed hormone combinations with known deleterious effects and projecting those effects to all estrogen-inclusive regimens.
It is a biased practice based on uninformed presumptions that such patients seek pretense and can not be considered as women themselves. Much of the confusion derives from a failure by practitioners to distinguish between Harry Benjamin Syndrome (HBS) and paraphilia.
However, the existence of the post-op HBS-born offers the opportunity for informative baseline comparisons when studying the unique health concerns of all men and women, HBS or not.
Urbana, IL, USA. The main estrogen in the female body is estradiol. Doctors often prescribe Hormone Replacement (HT) regimens that only mimic the effects of estradiol, such as conjugated estrogens an...
St. Louis, MO, USA. The triumvirate of sex hormones — estrogen, progesterone, and testosterone — have cycles of rise and fall in our bloodstreams that influence and respond to other changes...
Springfield, VA, USA. The hormone Oxytocin continues to attract serious research because of its natural support for nurturant social interactions. The acces point was the hormone's necessary role in milk ...
Malaga, Andalucia, Spain. There has been relatively little systematic study of the effects of long-term cross-sex hormone therapy in male-to-female (M2F) and female-to-male (F2M) transsexuals [cf. sidebar]. No...
New Haven, CT, USA. The naturally occurring female sex hormone estradiol plays an important role in maintaining skeletal health by balancing the ongoing processes of bone resorption and bone formation tha...
San Francisco, CA, USA. Atrazine, a common weedkiller in the U.S., already suspected of causing sexual abnormalities in frogs and fish, has now been found to alter hormonal signaling in human cells. The h...
Malaga, Andalucia, Spain. There has been relatively little systematic study of the effects of long-term cross-sex hormone therapy in male-to-female (M2F) and female-to-male (F2M) transsexuals [cf. sidebar]. Now, this is beginning to change. A research team from Hospital Regional Universitario Carlos Haya [N1] studied changes in the serum uric acid (urate) levels. Uric acid, an organic compound, is produced in large quantities by the normal human metabolism.
Ordinarily, people can have elevated levels of uric acid for variety of hereditary or dietary reasons. Any changes in may be an independent mortality factor of Coronary Heart Disease (CHD), cytokines, and various inflammatory markers. Cytokines are a general category of signalling proteins and glycoproteins, critical to the functioning of both innate and adaptive immune responses. Cellular communication depends on them , along with hormones and neurotransmitters.
Effect of Long-Term Administration of Cross-Sex Hormone Therapy on Serum and Urinary Uric Acid in Transsexual Persons. R. Yahyaoui, I. Esteva, J. J. Haro-Mora, M. C. Almaraz, S. Morcillo, G. Rojo-Martínez, J. Martínez, J. M. Gómez-Zumaquero, I. González, V. Hernando and F. Soriguer. Journal of Clinical Endocrinology & Metabolism 93(6) 2230-2233. doi: 10.1210 / jc.2007-2467.
The basis of this study, and a few others like it, is an analysis of the serum chemistry and possble health effects. Blood serum is derived from blood plasma [cf. sidebar] after the removal of blood cells, clotting factors, and other materials. The study of uric acid serum levels produced findings of general interest that were published in The Journal of Clinical Endocrinology & Metabolism.
Serum Uric Acid
Blood tests for uric acid measures the absolute amounts in a particular sample and makes it available for comparison with other members of a group. Most uric acid is filtered out by the kidneys, passing out of the body as a urinary flow. A small amount passes out of the body in stool.
However, if too much uric acid is produced — or if the kidneys can not remove it — there is a corresponding increase in the level of uric acid in the blood. High levels can cause solid crystals to form within joints, a painful condition called gout. If it remains untreated, these crystals can build up in the joints and nearby tissues, forming hard lumpy deposits (tophi). High levels of uric acid may also cause kidney stones or kidney failure.
Prior Studies
The authors of the current research cite prior epidemiological studies to suggest that their results may have some practical implications.
Increasing serum estrogen levels appear to decrease serum uric acid levels by increasing renal uric acid excretion in M2F transsexuals.
F2M transsexuals increase their uric acid levels, suggesting that a convenient observation exists for evaluating uric acid levels during cross-sex hormone therapy in this group.
Levels remained stable with observable effect from the first year, suggesting that the increase may have no clinical relevance. A longer follow-up might be necessary to confirm the long-term safety of therapy.
The results show the different metabolic response in the two groups of transsexuals depending on the dose of cross-sex hormone therapy.
That is, both feminization and masculinization has effects that converge with the situation of natal females and males.
The researchers found that transsexual persons offered a very suitable model to attempt clarification, at least in part, of questions that persist in the professional literature.
Plasma uric acid concentrations are higher in men than age-matched women, possibly due to a greater rate of clearance from the kidneys of women. Called renal clearance, the underlying mechanisms are not fully known.
There have been suggestions that renal clearance is facilitated by the the higher levels of estradiol in women, and a lower reabsorption of urate following urination.
Other studies defend the direct influence of insulin on the kidneys in the management of uric acid. [See the concluding portion of this article: Consideration Of Possible Insulin Resistance, below.]
.
The only prior study to examine the effect of sex steroids on uric acid in transsexuals found a reduction in plasma levels of uric acid and an increase in renal clearance and the fractional excretion of uric acid (FEUA). Nicholls et al. [N2] studied 22 M2F before, and 10 weeks after, treatment with estilbestrol or ethynilestradiol [N3]. They found no association between uric acid levels and excretion with estrogen dose, probably because almost all the subjects received the same dose. Moreover, they did not record the plasma levels of estradiol-17ß, essential to any explanation of estrogen's effect on uric acid metabolism [N4].
Summary of Findings
Dr. Federico Soriguer Escofet, coordinator, Jefe Servicio Endocrinología y Nutrición, Hospital Regional Universitario Carlos Haya. Dr. Soriguer was senior author of the study.
The research team examined the long-term effect of sex steroids on serum concentrations and FEUA in two goups transsexuals undergoing cross-sex hormone therapy: 22 were M2F and 47 were F2M (a cohort of 69 individuals). The study was approved by the hospital Ethics Committee and the participants gave written informed consent.
The transsexual cohort was selected consecutively provided they fulfilled the diagnostic criteria of the WPATH Standards of Care, had no history of prior cross-sex hormone treatment, and no known metabolic or inflammatory disease. Once accepted into the program of the Andalusian Gender Team (AGT), the subjects started hormone therapy with a minimum twoyear medical follow-up.
Male-to-Female. The mean age of the M2F was 23.1±9.4 years. Of the M2F group, 18 had received conjugated oral estrogens, one oral estradiol valerate and three transdermal estradiol patches. The daily estrogen dosage in the M2F was classified as:
low (0.625-1.250 mg conjugated estrogens or 1-2 mg of oral estradiol valerate or 50 μg of transdermal estradiol),
medium (1.875 mg conjugated estrogens or 3-4 mg of oral estradiol valerate or 75 μg of transdermal estradiol) and
high (more than 1.875 mg conjugated estrogen or more than 4 mg of oral estradiol valerate or 100 μg of transdermal estradiol).
A low dose is similar to that of HRT, medium dose twice that of HRT, and high dose above twice that of HRT (12-14). The number of M2F during the first year on low, medium or high doses of estrogens was 16, 6 and 0, respectively, and during the second year it was 13, 4 and 4, respectively. All the 4 M2F also received cyproterone acetate (50-100 mg per day).
Female-to-Male. The mean age of the F2M 25.7±6.0 years. In the FMT group, during the first year
93.3% received 250 mg intramuscular testosterone enantate or propionate each two weeks, and
6.7% had 5 mg per day testosterone in patches.
During the second year,
69.6% received injectable testosterone enantate or propionate and
30.5% received testosterone in patches or gel.
Overall observations. The team found that serum levels of uric acid and the FEUA are significantly altered as a result of cross-sex hormone therapy in persons with gender dysphoria and in an estrogen dose-dependent manner in M2F.
The current study of M2Fs supports the hypothesis that lower levels of uric acid in women are due to the effect of estrogens on the post-secretory tubular reabsorption of uric acid. The increased estrogen might improve insulin sensitivity resulting in increased FEUA and decreased serum uric acid. They note, however, that some studies (but not all) have found that estrogens increase peripheral insulin sensitivity.
Consideration Of Possible Insulin Resistance
The standard oral glucose tolerance test (OGTT) measures a body's ability to use glucose, a type of sugar, that is the body's main source of energy. Regarding insulin resistance (IR), studies of a general population of men with a normal OGTT found higher baseline levels of glycemia, uric acid and HOMA-IR (homeostasis model assessment-insulin resistance). However, there was an an association in women between serum uric acid levels, insulin and HOMA-IR.
Polderman et al. examined insulin sensitivity in 13 F2M and 18 M2F before and after four months of cross-sex hormone therapy. Both groups showed a slight but significant reduction in insulin sensitivity after treatment [N5]. However, another more recent study involving 20 M2F and 17 F2M found that, after one year of cross-sex hormone therapy, insulin sensitivity was only altered in the MFT group [N6].
The current study only showed a weak statistical correlation between levels of estradiol-17ß and HOMA-IR after one year’s treatment. The transsexuals treated with estrogens experienced no change in their HOMA-IR, nor in their body mass index (BMI). The researchers consider it unlikely that, if changes occurred in peripheral insulin sensitivity, they were sufficiently important to influence the FEUA.
In the F2M they found no clear association between testosterone doses/levels and FEUA, probably because most of the transsexuals used the same dose and because serum testosterone levels at a particular time do not represent the “status” of androgen impregnation during cross-sex hormone therapy, especially in those taking intramuscular enantate or propionate.
Another possibility is that the reduction in estrogens following cross-sex hormone therapy induces a decrease in FEAU and an increase in serum uric acid. Several authors have examined the influence of testosterone on uric acid levels, though the presence of such an association is still controversial (20-21). The F2M group experienced a significant fall in HOMA-IR after one year of treatment with testosterone, which does not agree with the suggestion that an increase in testosterone in healthy women causes hyperinsulinemia and insulin resistance [N7].
It is therefore very unlikely that the increase in serum levels of uric acid and the fall in FEUA in the F2M are due to the action of insulin; rather, it is secondary to androgen treatment and/or the reduction in endogenous estrogens.
[N1] This work was partly financed by a grant from the Andalusian Health Service.
[N2] Effect of oestrogen therapy on plasma and urinary levels of uric acid. Nicholls A, Snaith ML, Scott JT 1973. BMJ 1:449-451.
[N3] Ethynilestradiol is a form of estrogen usually associated with birth control polls. It is commonly prescribed to HBS/TS patients. While powerful, it has known deleterious effects.
[N4] Estradiol-17ß is a relatively safe form of estrogen and most in alignment with female physiology. It can be prescribed to HBS/TS patients with greater confidence than ethynilestradiol [N3], especially if combined with a true progstin (e.g., prometrium).
[N5] Induction of insulin resistance by androgens and estrogens. Polderman KH, Gooren LJG, Asscheman H, Bakker A, Heine RJ 1993. J Clin Endocrinol Metab 79(1):265-271.
[N6] Effects of sex steroids on components of the insulin resistance syndrome in transsexual subjects. Elbers JM, Giltay EJ, Teerlink T, Scheffer PG, Asscheman H, Seidell JC, Gooren LJ 2003. Clin Endocrinol (Oxf) 58(5):562-571.
[N7] Correlation of hyperandrogenism with hyperinsulinism in polycystic ovarian disease. Burghen GA, Givens JR, Kitabchi AE 1980. J Clin Endocrinol Metab 50:113-116.
Effect of Long-Term Administration of Cross-Sex Hormone Therapy on Serum and Urinary Uric Acid in Transsexual Persons. R. Yahyaoui, I. Esteva, J. J. Haro-Mora, M. C. Almaraz, S. Morcillo, G. Rojo-Martínez, J. Martínez, J. M. Gómez-Zumaquero, I. González, V. Hernando and F. Soriguer. Journal of Clinical Endocrinology & Metabolism 93(6) 2230-2233. doi: 10.1210 / jc.2007-2467. [ Author's Manuscript PDF ]
Abstract
Background. Transsexual persons afford a very suitable model to study the effect of sex steroids on uric acid metabolism.
Design. This was a prospective study to evaluate the uric acid levels and fractional excretion of uric acid (FEUA) in a cohort of 69 healthy transsexual persons, 22 male-to-female transsexuals (MFTs) and 47 female-to-male transsexuals (FMTs). The subjects were studied at baseline and 1 and 2 yr after starting cross-sex hormone treatment.
Results. The baseline levels of uric acid were higher in the MFT group. Compared with baseline, uric acid levels had fallen significantly after 1 yr of hormone therapy in the MFT group and had risen significantly in the FMT group. The baseline FEUA was greater in the FMT group. After 2 yr of cross-sex hormone therapy, the FEUA had increased in MFTs (P = 0.001) and fallen in FMTs (P = 0.004). In MFTs, the levels of uric acid at 2 yr were lower in those who had received higher doses of estrogens (P = 0.03), and the FEUA was higher (P = 0.04). The FEUA at 2 yr was associated with both the estrogen dose (P = 0.02) and the serum levels of estradiol-17β (P =0.03). In MFTs, a correlation was found after 2 yr of therapy between the homeostasis model assessment of insulin resistance and the serum uric acid (r = 0.59; P = 0.01).
Conclusions. Serum levels of uric acid and the FEUA are altered in transsexuals as a result of cross-sex hormone therapy. The results concerning the MFT group support the hypothesis that the lower levels of uric acid in women are due to estrogen-induced increases in FEUA.
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The majority of the feminist movement has really been horrible to transsexuals and transgendered people even though the reproductive rights movement offers a very clear parallel.
If women have a right to control their own bodies, even to the extent that they have the right to abort a fœtus then surely people have a right to change their bodies in terms of their secondary sex characteristics.
The Human Genome Project (HGP). The HGP identified all of the genes in the human genome and mapped their individual sequencing. Basic work began in 1990 and reached completion in 2005, sparking continuous refinements and new projects. Though the HGP is finished, data analyses will continue for many years.
A genome is all the DNA in an organism, including its genes and other materials. Genes carry information for making all the proteins required by all organisms. These proteins determine, among other things, how the organism looks, how well its body metabolizes food or fights infection, and to an extent even how it behaves.
DNA is made up of four similar chemicals (called bases and abbreviated A, T, C, and G) that are repeated millions or billions of times throughout a genome. The human genome, for example, has 3 billion pairs of bases. The particular order of As, Ts, Cs, and Gs is extremely important.
The order underlies all of life's diversity, even dictating whether an organism is human or another species such as yeast, rice, or fruit fly, all of which have their own genomes and are themselves the focus of genome projects. Because all organisms are related through similarities in DNA sequences, insights gained from nonhuman genomes often lead to new knowledge about human biology.
Video:An introduction to the ongoing Human Genome Project, courtesy of the US National Institutes of Health NIH) (18 May 2007). Time: 00:03:33. Creative Commons license: Attribution-NonCommercial-NoDerivs.
Technicians prepare blood plasma by spinning a tube of fresh blood in a centrifuge until the blood cells migrate to the bottom of the tube. The blood plasma is then poured or drawn off for use or further processing. 
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