Very low quality evidence suggests that sex reassignment that includes hormonal interventions in individuals with GID likely improves gender dysphoria, psychological functioning and comorbidities, sexual function and overall quality of life.

SummaryObjective To summarize the available evidence on the cardiovascular effects of cross-sex steroid use in transsexuals. Methods We searched relevant electronic databases and sought additional references from experts. Eligible studies reported on cardiovascular events, venous thromboembolism, blood pressure and fasting serum lipids. Data were extracted in duplicate. We used the random-effects model to estimate the pooled weighted mean difference (WMD) and 95% confidence intervals (CIs). Results We found 16 eligible studies, mostly uncontrolled cohorts of varied follow-up durations (1471 male-to-female (MF) and 651 female-to-male (FM) individuals). In the MF individuals, cross-sex hormone use was associated with a statistically significant increase in fasting serum triglycerides without changes in the other parameters (WMD = 23AE39 mg/dl; 95% CI = 4AE82-41AE95). In the FM individuals, there was a similar increase of triglycerides (WMD = 31AE35 mg/dl; 95% CI = 7AE53-55AE17) and a reduction of high density lipoprotein (HDL)-cholesterol (WMD = )6AE09 mg/ dl; 95% CI = )11AE44 to )0AE73). There was a statistically significant but clinically trivial increase in systolic blood pressure (WMD = 1AE74 mmHg; 95% CI = 0AE21-3AE27). Analyses were associated with significant heterogeneity across studies. There were very few reported cardiovascular events (deaths, strokes, myocardial infarctions or venous thromboembolism), more commonly among MF individuals. Conclusions Very low quality evidence, downgraded due to methodological limitations of included studies, imprecision and heterogeneity, suggests that cross-sex hormone therapies increase serum triglycerides in MF and FM and have a trivial effect on HDL-cholesterol and systolic blood pressure in FM. Data about patient important outcomes are sparse and inconclusive.

Background: Intravenous Leiomyomatosis(IVL)is a rare, histological benign but biological behavior malignant tumor. Literature reports on IVL are less than 200 cases, and most majority of them are individual reports.Methods: Six patients with intravenous leiomyomatosis involved in the cava inferior vena were analyzed.Results: Three patients received one-stage operation and two received two-stage operation. All the operations were successful. No perioperative death or other complications were observed. Among the six patients, primary tumor and intravenous tumor embolus were completely resected from four patients. Residual tumor was remained in one patient who had serious adherence due to multiple operations. However, with the anti-estrogen therapy, the residual tumor had significantly regressed. All the patients had tumor relapse after the operation.Conclusion: We believe that IVL is group of disease and not a single disease entity. Although IVL is extremely rare, vascular surgeon must pay more attention to this disease. There are many therapeutic methods to choose from when uterine leiomyomatosis involves the cava inferior vena, among which operation is the best choice. Anti-estrogen therapy seems to be justified in patients with ER(ϩ) and PR(ϩ).

ObjectiveRecent studies have suggested that female sexual dysfunction may be has high as 40% in the United States and yet very few studies have examined sexual dysfunction in Hispanic women. Our previous studies suggested that low testosterone levels may be associated with both subjective and objective sexual dysfunction in hypopituitary women. Are there differences in testosterone levels, subjective and objective measures of sexual function between Hispanic and non-Hispanic females?MethodSubjective sexual function was assessed by the Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale (FSDS) on 15 Hispanic and 10 non-Hispanic women. Total testosterone levels were measured. Objective sexual function measurements were by duplex Doppler ultrasound to assess clitoral blood flow before and after sexual stimulation. Medoc's GenitoSensory Analyzer-3000 was used to assess quantitative somatosensory thresholds of vibratory sensation.ResultsHispanic women did have a larger BMI that was statistically significant (29.05 ± 4.32 vs 24.30 ± 4.86, p = .0115). Hispanic women did have lower total testosterone levels but the results were not statistically significant (24.02 ± 1.25 ng/dL vs 37.75 ± 24.76 ng/dL, p = .3487). The Female Sexual Function Index (FSFI) suggested no statistically significant differences between Hispanic and non-Hispanic women scores on desire, satisfaction, orgasm, arousal, lubrication, and pain. On the Female Sexual Distress Scale, Hispanic women had more personal sexual distress than non-Hispanic women as suggested by a higher score (5.33 ± 6.66 vs 0.50 ± 1.22); however, these results were not statistically significant (p = .0952). On the objective tests, Hispanic women had less vaginal sensitivity than non-Hispanic patients as suggested by measurements of vaginal vibratory thresholds (4.25 ± 1.66 vs 2.03 ± 0.88 microns) that were statistically significant (p = .04); a higher number suggests less sensitivity. Hispanic women had greater changes in clitoral blood flow after sexual stimulation (38.88 ± 17.83 cm/sec vs 18.96 ± 9.36 cm/sec); however, these results were not statistically significant (p = .0727).ConclusionsThere were statistically significant differences between Hispanic and non-Hispanic women in BMI and vaginal vibratory sensations. Hispanic women experienced more personal sexual distress, had lower total testosterone levels, and had greater changes in clitoral blood flow after sexual stimulation.

ObjectiveThe psychological and physiological role of testosterone in women sexual function remains poorly understood. Women with hypopituitarism have severely diminished ovarian and adrenal androgen production and thus represent an excellent model to study the consequences of androgen deficiency. We hypothesized that women with hypopituitarism would exhibit altered sexual function as a result of androgen deficiency.MethodTotal testosterone, objective sexual function (blood flow and somatosensory thresholds) and the subjective Female Sexual Function Index (FSFI) were measured in 15 women with documented hypopituitarism (median age 37.5±7.1, BMI 28.1±5.2) and 9 aged matched healthy volunteers (median age 26±9.2, BMI 25.6±4.2) in an IRB-approved study.ResultsTotal testosterone levels were markedly diminished among women with hypopituitarism (4.74±3.92 ng/dl) compared to normal volunteers (25.5±2.7 ng/dl, p≤0.0002). Although pre-stimulation of clitoral and labial blood flow were similar between the groups in this study, there was a trend toward decreased post-stimulation clitoral blood flow in patients with hypopituitarism (36±5.6 cm/sec) compared with healthy volunteers (48.5±4.9 cm/sec). Moreover, the hypopituitary patients (17.2±5.3 cm/sec, p≤0.05) showed decreased clitoral blood flow increment following stimulation compared to the healthy volunteers (29.5±5.2 cm/sec). Quantitative somatosensory testing showed statistically significant (p≤0.05) impairment in vibratory and thermal thresholds in patients with hypopituitarism compared to healthy volunteers. All areas (desire, arousal, lubrication, orgasm, satisfaction and pain) of the subjective FSFI in hypopituitary patients showed statistically significant (p≤0.0002) impairment compared to controls.ConclusionBased on this data, we postulate that testosterone deficiency in women with hypopituitarism leads to impairment in both physiological and subjective sexual function. These data provide compelling rationale for placebo-controlled, randomized trials of testosterone replacement in women with hypopituitarism.