Analysis of information sources in references of the Wikipedia article "女性化激素疗法" in Chinese language version.
如前所述,CPA会导致血浆睾酮水平的不完全抑制,降低约70%并保持在去势值的三倍左右。[Rennie等人]发现CPA与极低剂量(0.1 mg/d)的DES联合使用可以非常有效地去除血浆睾酮和组织中的双氢睾酮雄激素。[...]该方案结合了两种化合物的睾酮降低作用,因此只需少量雌激素即可将血浆睾酮降低至接近去势水平。(CPA, as mentioned earlier, leads to an incomplete suppression of plasma testosterone levels, which decrease by about 70% and remain at about three times castration values. [Rennie et al.] found that the combination of CPA with an extremely low dose (0.1 mg/d) of DES led to a very effective withdrawal of androgens in terms of plasma testosterone and tissue dihydrotestosterone. [...] this regimen combines the testosterone-reducing effects of two compounds, therefore, only small amounts of estrogen are required to bring down plasma testosterone to approximately castrate levels.)
[...]在第一次注射亮丙瑞林之前进行雌激素或抗雄激素治疗可能会降低[治疗开始时由睾酮“爆发”引起的症状风险](16)。([...] estrogen or antiandrogen treatment prior to the first leuprolide injection may reduce [the risk of symptoms caused by the testosterone "flare" at the initiation of treatment] (16).)
在实验上,我已经能够诱导一名男性异装癖者的泌乳,该男性异装癖者的睾丸在几年前已被切除,其乳房在很长一段时间内使用芪雌酚和乙炔雌酮,发育已良好[9]。1955年7月9日,皮下植入600 mg雌二醇,每周注射50 mg孕酮,持续四个月。下个月每天注射10 mg二丙酸雌二醇和50 mg孕酮。这些注射又持续了一个月,将孕酮增加到每天100 mg。然后停用两种激素,逐日增加剂量注射催乳素和生长激素,持续四天;同时,患者每天使用吸乳器四次,每次5分钟。在此期间,乳腺静脉明显增大,在第六天和第七天收集到了1到2 mg乳状液体。(Experimentally I have been able to induce lactogenesis in a male transvestite whose testes had been removed some years before and whose breasts had been well developed over a long period with stilbestrol and ethisterone.9 In July, 1955, 600 mg. of estradiol was implanted subcutaneously and weekly injections of 50 mg. of progesterone were given for four months. For the next month daily injections of 10 mg. estradiol dipropionate and 50 mg. progesterone were given. These injections were continued for another month, increasing progesterone to 100 mg. daily. Both hormones were then withdrawn, and daily injections of increasing doses of prolactin and somatotropin were given for four days; at the same time, the patient used a breast bump four times daily for 5 minutes on both sides. During this time the mammary veins were visibly enlarged and on the sixth and seventh days 1 to 2 cc. of milky fluid was collected.)
Spironolactone is an aldosterone antagonist and a relatively weak antiandrogen that blocks the AR and inhibits androgen biosynthesis.
雌激素是下丘脑-垂体-睾丸轴的高效抑制剂(212-214)。除了它们在下丘脑和垂体水平的负反馈作用外,还可能对睾丸产生直接抑制作用(215,216)。[...][用雌激素治疗的]睾丸组织学显示曲细精管紊乱、空泡化和管腔缺失,以及精子发生的区室化。(Estrogens are highly efficient inhibitors of the hypothalamic-hypophyseal-testicular axis (212–214). Aside from their negative feedback action at the level of the hypothalamus and pituitary, direct inhibitory effects on the testis are likely (215,216). [...] The histology of the testes [with estrogen treatment] showed disorganization of the seminiferous tubules, vacuolization and absence of lumen, and compartmentalization of spermatogenesis.)
雌激素主要通过下丘脑-垂体水平的负反馈来减少LH分泌和睾丸雄激素合成。[...]有趣的是,如果不间断地暴露,3年后停止雌激素治疗,血清睾酮可能会保持在去势水平长达3年。这种长期抑制被认为是雌激素对睾丸间质细胞的直接影响所致。(Estrogens act primarily through negative feedback at the hypothalamic-pituitary level to reduce LH secretion and testicular androgen synthesis. [...] Interestingly, if the treatment with estrogens is discontinued after 3 yr. of uninterrupted exposure, serum testosterone may remain at castration levels for up to another 3 yr. This prolonged suppression is thought to result from a direct effect of estrogens on the Leydig cells.)
Therapy with GnRH analogs is expensive and requires intramuscular injections of depot formulations, the insert of a subcutaneous implant yearly, or, much less commonly, daily subcutaneous injections.
Treatment is expensive, with costs typically in the range of $10,000–$15,000 per year.
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为空 (帮助)有人建议在每个雌激素治疗周期的最后一周添加孕激素,以形成更圆润的乳房,而不是这些患者中出现的锥形乳房,但我们无法检测到乳房轮廓在有没有孕激素情况下的差异。(It has been suggested that progestins be added during the last week of each cycle of estrogen therapy in order to develop more rounded breasts rather than the conical breasts many of these patients develop, but we have been unable to detect any difference in breast contour with or without progestins.)
雌激素刺激乳头生长,乳腺终末导管分支发展到形成导管的阶段,脂肪基质生长至构成乳房质量的约85%。[...]初潮前后,当末端导管分支形成多个盲囊芽时,乳腺小叶出现。这些效果是由于有孕酮存在。[...]完整的小泡发育通常仅在怀孕期间,在额外的孕酮和催乳素的影响下发生。(Estrogen stimulates the nipples to grow, mammary terminal duct branching to progress to the stage at which ductules are formed, and fatty stromal growth to increase until it constitutes about 85% of the mass of the breast. [...] Lobulation appears around menarche, when multiple blind saccular buds form by branching of the terminal ducts. These effects are due to the presence of progesterone. [...] Full alveolar development normally only occurs during pregnancy under the influence of additional progesterone and prolactin.)
在整个生育期,一些女性在月经开始前的每个月经周期后期都会注意到乳房肿胀。在月经周期的这个阶段,乳房组织的保水和随后的肿胀被认为是由于高水平的循环孕酮刺激了乳房的分泌细胞。(Throughout the reproductive years, some women note swelling of the breast around the latter part of each menstrual cycle before the onset of menstruation. The water retention and subsequent swelling of breast tissue during this phase of the menstrual cycle are thought to be due to high levels of circulating progesterone stimulating the secretory cells of the breast.12)
最近,Foss(1956)尝试在一名被阉割的男性异装癖者中开始哺乳。给他植入了500 mg的雌二醇,10个月后,又植入了600 mg的雌二醇,随后每天注射二丙酸雌二醇和黄体酮,持续6周。停药后立即每天注射22·9 mg催乳素,连续3天,但没有效果。在每天用雌二醇和黄体酮治疗的第二个月后,他被给予催乳素和生长激素联合注射4天,每天使用吸乳器抽吸4次。在第四天和第五天,从右侧乳头挤出几滴初乳。这是现代激素知识在男性中的一个可能应用,值得进一步试验。(Recently, an attempt has been made by Foss (1956) to initiate lactation in a castrated male transvestist. He was given an implant of 500 milligrams of oestradiol, and 10 months later, a further 600 milligrams of oestradiol, followed by daily injections of oestradiol dipropionate and progesterone for 6 weeks. Immediately after withdrawal of this treatment, 22·9 milligrams of prolactin were injected daily for 3 days but without effect. After a second month of treatment with oestradiol and progesterone daily, he was given combined injections of prolactin and somatotrophin for 4 days, suction with a breast-pump being employed 4 times daily. On the fourth and fifth days a few drops of colostrum were expressed from the right nipple. There is a possible application here of modern hormone knowledge to man, and further trials would be of interest.)
[...]对男性变性者的观察(Wyss和DelPozo未发表)表明,在人类男性中也可以类似地实现泌乳诱导。[...]([...] An observation (Wyss and Del Pozo unpublished) in a male transsexual showed that induction of lactation can be similarly achieved in the human male. [...])
仅仅2年后,温弗瑞进行的另一次采访,引发了许多观众相同的反应。在2010年的这一集中,女同性恋伙伴克里斯汀·麦金博士和丽莎·博茨抱着他们的双胞胎婴儿时喜极而泣。再一次,当人们发现美丽的克里斯汀是一位男到女变性人,曾经是一位英俊的军官克里斯时,观众的下巴都掉了下来,而丽莎使用克里斯汀在性别确认手术之前储存的精子生下了她们的亲生孩子[10]。当温弗瑞观看克里斯汀母乳喂养她们孩子的视频时,温弗瑞的下巴差点撞到地板上(这一集在网上称为“成为自己孩子父亲的妈妈”)。[...](Just 2 years later, Winfrey would feature another interview that elicited many of the same audience reactions. In this 2010 episode, lesbian partners Dr. Christine McGinn and Lisa Bortz beamed with joy as they held their infant twins. Again, audience members' jaws dropped when it was revealed that beautiful Christine was a male-to-female transsexual who used to be a handsome military officer Chris, and that Lisa had given birth to the couple's biological children using sperm Chris banked prior to gender confirmation surgeries.10 And it was Winfrey's chin that nearly hit the floor as she watched video of Christine breastfeeding the couples' children (the episode is referred to online as "The Mom Who Fathered Her Own Children"). [...])
When we prescribed estradiol, we preferred sublingual estradiol valerate instead of the oral form for feminizing HT since prior researchers have reported the effectiveness of sublingual administration in maintaining high blood estradiol concentration and low E1/E2 ratio [13].
There are several classes of antiandrogens including (1) antigonadotropins (eg, LHRH agonists/antagonists, synthetic estrogens [diethylstilbestrol]); (2) nonsteroidal androgen-receptor antagonists (eg, flutamide, bicalutamide, nilutamide); (3) steroidal agents with mixed actions (eg, cyproterone acetate); (4) adrenal androgen inhibitors (eg, ketoconazole, hydrocortisone); (5) steroidal agents that inhibit androgen biosynthesis (eg, 5α-reductase inhibitors (type II) and dual-acting 5α-reductase inhibitors); [...]
如前所述,CPA会导致血浆睾酮水平的不完全抑制,降低约70%并保持在去势值的三倍左右。[Rennie等人]发现CPA与极低剂量(0.1 mg/d)的DES联合使用可以非常有效地去除血浆睾酮和组织中的双氢睾酮雄激素。[...]该方案结合了两种化合物的睾酮降低作用,因此只需少量雌激素即可将血浆睾酮降低至接近去势水平。(CPA, as mentioned earlier, leads to an incomplete suppression of plasma testosterone levels, which decrease by about 70% and remain at about three times castration values. [Rennie et al.] found that the combination of CPA with an extremely low dose (0.1 mg/d) of DES led to a very effective withdrawal of androgens in terms of plasma testosterone and tissue dihydrotestosterone. [...] this regimen combines the testosterone-reducing effects of two compounds, therefore, only small amounts of estrogen are required to bring down plasma testosterone to approximately castrate levels.)
[醋酸甲羟孕酮]使血浆睾酮水平暂时降低至略高于去势男性的水平。当以40 mg tid的剂量使用时,与0.5–1.5 mg/d的雌二醇联合使用,可协同抑制垂体促性腺激素,并将血浆睾酮维持在去势水平长达一年。([Megestrol acetate] produces a transient reduction in plasma testosterone to levels somewhat higher than those in castrated men. When used in a dose of 40 mg tid, in combination with estradiol 0.5–1.5 mg/d, it acts synergistically to suppress pituitary gonadotropins and maintain plasma testosterone at castration levels for periods up to one year.)
非甾体抗雄激素包括氟他胺、尼鲁米特和比卡鲁胺,它们不会降低雄激素水平,可能对想要保持性欲和生育能力的个体有利[9]。(Non-steroidal antiandrogens include flutamide, nilutamide, and bicalutamide, which do not lower androgen levels and may be favorable for individuals who want to preserve sex drive and fertility [9].)
传统上,建议患者在开始异性激素治疗之前冷冻保存精子,因为随着时间的推移,高剂量雌激素治疗可能会降低精子活力(Lubbert等,1992)。然而,由于研究有限,雌激素治疗导致的生育力下降仍有争议。(Traditionally, patients have been advised to cryopreserve sperm prior to starting cross-sex hormone therapy as there is a potential for a decline in sperm motility with high-dose estrogen therapy over time (Lubbert et al., 1992). However, this decline in fertility due to estrogen therapy is controversial due to limited studies.)
[...]在第一次注射亮丙瑞林之前进行雌激素或抗雄激素治疗可能会降低[治疗开始时由睾酮“爆发”引起的症状风险](16)。([...] estrogen or antiandrogen treatment prior to the first leuprolide injection may reduce [the risk of symptoms caused by the testosterone "flare" at the initiation of treatment] (16).)
[...]建议在为男性到女性的跨性别者开具口服非那雄胺的处方时要谨慎,因为该药物与诱发抑郁、焦虑和自杀意念有关,这些症状在性别不安患者中尤为常见,他们已经处于高风险中[9]。([...] caution is recommended while prescribing oral finasteride to male-to-female transsexuals, as the drug has been associated with inducing depression, anxiety and suicidal ideation, symptoms that are particularly common in patients with gender dysphoria, who are already at a high risk.[9])
脂肪细胞占人体乳房的大部分,而上皮细胞仅占人体乳房体积的约10%。(Adipocytes make up the bulk of the human breast, with epithelial cells accounting for only approximately 10% of human breast volume.)
在基质中,纤维和脂肪组织的数量增加,成人非哺乳期乳房由80%或更多的基质组成。(In the stroma, there is an increase in the amount of fibrous and fatty tissue, with the adult nonlactating breast consisting of 80% or more of stroma.)
雌激素刺激乳头的发育,从乳腺导管分叉到小管形成阶段的过程,及脂肪基质生长至构成乳房质量的约85%。(Estrogen stimulates growth of the nipples, progression of mammary duct branching to the stage at which ductiles are formed, and fatty stromal growth until it constitutes about 85% of the mass of the breast.)
在实验上,我已经能够诱导一名男性异装癖者的泌乳,该男性异装癖者的睾丸在几年前已被切除,其乳房在很长一段时间内使用芪雌酚和乙炔雌酮,发育已良好[9]。1955年7月9日,皮下植入600 mg雌二醇,每周注射50 mg孕酮,持续四个月。下个月每天注射10 mg二丙酸雌二醇和50 mg孕酮。这些注射又持续了一个月,将孕酮增加到每天100 mg。然后停用两种激素,逐日增加剂量注射催乳素和生长激素,持续四天;同时,患者每天使用吸乳器四次,每次5分钟。在此期间,乳腺静脉明显增大,在第六天和第七天收集到了1到2 mg乳状液体。(Experimentally I have been able to induce lactogenesis in a male transvestite whose testes had been removed some years before and whose breasts had been well developed over a long period with stilbestrol and ethisterone.9 In July, 1955, 600 mg. of estradiol was implanted subcutaneously and weekly injections of 50 mg. of progesterone were given for four months. For the next month daily injections of 10 mg. estradiol dipropionate and 50 mg. progesterone were given. These injections were continued for another month, increasing progesterone to 100 mg. daily. Both hormones were then withdrawn, and daily injections of increasing doses of prolactin and somatotropin were given for four days; at the same time, the patient used a breast bump four times daily for 5 minutes on both sides. During this time the mammary veins were visibly enlarged and on the sixth and seventh days 1 to 2 cc. of milky fluid was collected.)
[...]进行了外生殖器去势和女性化整形手术[...]手术后一段时间,患者对生活重新产生了兴趣。经过手术和荷尔蒙矫正后,患者不可抗拒地发展出母性本能。未婚,患者获准领养孩子,模拟怀孕,带着儿子从妇产医院出院。从“出生”后的第一天开始,溢乳急剧增加,出现自发流出乳汁,伴溢乳(+++)。婴儿一直母乳喂养到6个月大。[...]我们的信息是文献中第二例有关男性易性症患者溢乳的描述。R.[Flückiger]等人于1983年首次描述了这种类型(6)。这一观察结果证明了泌乳发育机制与一个人的遗传性别相独立,并且对男性发生药物性溢乳的可能性感到担忧。([...] castration and feminizing plastic surgery of the external genitalia was performed [...] Some time after the operation, the patient developed a renewed interest in life. After the surgical and hormonal correction, the patient irresistibly developed maternal instincts. Unmarried, the patient obtained permission for the adoption of a child, simulated pregnancy, and was discharged from the maternity hospital with a son. From the first days after the “birth”, galactorrhea sharply increased, and spontaneous outflow of milk appeared, with galactorrhea (+++). The baby was breastfed up to 6 months of age. [...] Our message is the second in the world literature describing galactorrhea in a male patient with transsexualism. The first description of this kind was made in 1983 by R. [Flückiger] et al. (6). This observation demonstrates the independence of the mechanism of lactation development from one’s genetic sex and is alarming with regard to the possibility of drug-induced galactorrhea development in men.)
When we prescribed estradiol, we preferred sublingual estradiol valerate instead of the oral form for feminizing HT since prior researchers have reported the effectiveness of sublingual administration in maintaining high blood estradiol concentration and low E1/E2 ratio [13].
There are several classes of antiandrogens including (1) antigonadotropins (eg, LHRH agonists/antagonists, synthetic estrogens [diethylstilbestrol]); (2) nonsteroidal androgen-receptor antagonists (eg, flutamide, bicalutamide, nilutamide); (3) steroidal agents with mixed actions (eg, cyproterone acetate); (4) adrenal androgen inhibitors (eg, ketoconazole, hydrocortisone); (5) steroidal agents that inhibit androgen biosynthesis (eg, 5α-reductase inhibitors (type II) and dual-acting 5α-reductase inhibitors); [...]
[醋酸甲羟孕酮]使血浆睾酮水平暂时降低至略高于去势男性的水平。当以40 mg tid的剂量使用时,与0.5–1.5 mg/d的雌二醇联合使用,可协同抑制垂体促性腺激素,并将血浆睾酮维持在去势水平长达一年。([Megestrol acetate] produces a transient reduction in plasma testosterone to levels somewhat higher than those in castrated men. When used in a dose of 40 mg tid, in combination with estradiol 0.5–1.5 mg/d, it acts synergistically to suppress pituitary gonadotropins and maintain plasma testosterone at castration levels for periods up to one year.)
非甾体抗雄激素包括氟他胺、尼鲁米特和比卡鲁胺,它们不会降低雄激素水平,可能对想要保持性欲和生育能力的个体有利[9]。(Non-steroidal antiandrogens include flutamide, nilutamide, and bicalutamide, which do not lower androgen levels and may be favorable for individuals who want to preserve sex drive and fertility [9].)
[...]在第一次注射亮丙瑞林之前进行雌激素或抗雄激素治疗可能会降低[治疗开始时由睾酮“爆发”引起的症状风险](16)。([...] estrogen or antiandrogen treatment prior to the first leuprolide injection may reduce [the risk of symptoms caused by the testosterone "flare" at the initiation of treatment] (16).)
[...]建议在为男性到女性的跨性别者开具口服非那雄胺的处方时要谨慎,因为该药物与诱发抑郁、焦虑和自杀意念有关,这些症状在性别不安患者中尤为常见,他们已经处于高风险中[9]。([...] caution is recommended while prescribing oral finasteride to male-to-female transsexuals, as the drug has been associated with inducing depression, anxiety and suicidal ideation, symptoms that are particularly common in patients with gender dysphoria, who are already at a high risk.[9])
脂肪细胞占人体乳房的大部分,而上皮细胞仅占人体乳房体积的约10%。(Adipocytes make up the bulk of the human breast, with epithelial cells accounting for only approximately 10% of human breast volume.)
在基质中,纤维和脂肪组织的数量增加,成人非哺乳期乳房由80%或更多的基质组成。(In the stroma, there is an increase in the amount of fibrous and fatty tissue, with the adult nonlactating breast consisting of 80% or more of stroma.)
雌激素刺激乳头的发育,从乳腺导管分叉到小管形成阶段的过程,及脂肪基质生长至构成乳房质量的约85%。(Estrogen stimulates growth of the nipples, progression of mammary duct branching to the stage at which ductiles are formed, and fatty stromal growth until it constitutes about 85% of the mass of the breast.)
在实验上,我已经能够诱导一名男性异装癖者的泌乳,该男性异装癖者的睾丸在几年前已被切除,其乳房在很长一段时间内使用芪雌酚和乙炔雌酮,发育已良好[9]。1955年7月9日,皮下植入600 mg雌二醇,每周注射50 mg孕酮,持续四个月。下个月每天注射10 mg二丙酸雌二醇和50 mg孕酮。这些注射又持续了一个月,将孕酮增加到每天100 mg。然后停用两种激素,逐日增加剂量注射催乳素和生长激素,持续四天;同时,患者每天使用吸乳器四次,每次5分钟。在此期间,乳腺静脉明显增大,在第六天和第七天收集到了1到2 mg乳状液体。(Experimentally I have been able to induce lactogenesis in a male transvestite whose testes had been removed some years before and whose breasts had been well developed over a long period with stilbestrol and ethisterone.9 In July, 1955, 600 mg. of estradiol was implanted subcutaneously and weekly injections of 50 mg. of progesterone were given for four months. For the next month daily injections of 10 mg. estradiol dipropionate and 50 mg. progesterone were given. These injections were continued for another month, increasing progesterone to 100 mg. daily. Both hormones were then withdrawn, and daily injections of increasing doses of prolactin and somatotropin were given for four days; at the same time, the patient used a breast bump four times daily for 5 minutes on both sides. During this time the mammary veins were visibly enlarged and on the sixth and seventh days 1 to 2 cc. of milky fluid was collected.)
[...]进行了外生殖器去势和女性化整形手术[...]手术后一段时间,患者对生活重新产生了兴趣。经过手术和荷尔蒙矫正后,患者不可抗拒地发展出母性本能。未婚,患者获准领养孩子,模拟怀孕,带着儿子从妇产医院出院。从“出生”后的第一天开始,溢乳急剧增加,出现自发流出乳汁,伴溢乳(+++)。婴儿一直母乳喂养到6个月大。[...]我们的信息是文献中第二例有关男性易性症患者溢乳的描述。R.[Flückiger]等人于1983年首次描述了这种类型(6)。这一观察结果证明了泌乳发育机制与一个人的遗传性别相独立,并且对男性发生药物性溢乳的可能性感到担忧。([...] castration and feminizing plastic surgery of the external genitalia was performed [...] Some time after the operation, the patient developed a renewed interest in life. After the surgical and hormonal correction, the patient irresistibly developed maternal instincts. Unmarried, the patient obtained permission for the adoption of a child, simulated pregnancy, and was discharged from the maternity hospital with a son. From the first days after the “birth”, galactorrhea sharply increased, and spontaneous outflow of milk appeared, with galactorrhea (+++). The baby was breastfed up to 6 months of age. [...] Our message is the second in the world literature describing galactorrhea in a male patient with transsexualism. The first description of this kind was made in 1983 by R. [Flückiger] et al. (6). This observation demonstrates the independence of the mechanism of lactation development from one’s genetic sex and is alarming with regard to the possibility of drug-induced galactorrhea development in men.)
基于催乳理论,并受到Lyons、Li、Johnson&Cole[1955]在雄性大鼠中成功产生泌乳的激励,尝试在男性异装癖者中启动催乳。六年前,该患者接受了雌激素治疗。然后切除睾丸和阴茎,并通过整形手术构建人造阴道。该患者在1954年9月植入了500 mg雌二醇,在1955年7月植入了600 mg。然后每天注射二丙酸雌二醇和孕酮,持续6周,使乳房发育更加快速。停止该治疗后立即每天注射催乳素22·9 mg,连续3天无效。每天服用雌二醇和孕酮的第二个月后,联合注射催乳素和生长激素,持续4天,并通过吸乳器进行抽吸,每天4次。在第4天和第5天,从右侧乳头挤出几滴初乳。(Based on the theories of lactogenesis and stimulated by the success of Lyons, Li, Johnson & Cole [1955], who succeeded in producing lactation in male rats, an attempt was made to initiate lactogenesis in a male transvestist. Six years ago this patient had been given oestrogens. Both testes and penis were then removed and an artificial vagina was constructed by plastic surgery. The patient was implanted with 500 mg oestradiol in September 1954, and 600 mg in July 1955. The breasts were then developed more intensively with daily injections of oestradiol dipropionate and progesterone for 6 weeks. Immediately following withdrawal of this treatment, prolactin 22·9 mg was injected daily for 3 days without effect. After a second month on oestradiol and progesterone daily, combined injections of prolactin and somatotrophin were given for 4 days and suction was applied by a breast pump-four times daily. On the 4th and 5th days a few drops of colostrum were expressed from the right nipple.)
[醋酸甲羟孕酮]使血浆睾酮水平暂时降低至略高于去势男性的水平。当以40 mg tid的剂量使用时,与0.5–1.5 mg/d的雌二醇联合使用,可协同抑制垂体促性腺激素,并将血浆睾酮维持在去势水平长达一年。([Megestrol acetate] produces a transient reduction in plasma testosterone to levels somewhat higher than those in castrated men. When used in a dose of 40 mg tid, in combination with estradiol 0.5–1.5 mg/d, it acts synergistically to suppress pituitary gonadotropins and maintain plasma testosterone at castration levels for periods up to one year.)
非甾体抗雄激素包括氟他胺、尼鲁米特和比卡鲁胺,它们不会降低雄激素水平,可能对想要保持性欲和生育能力的个体有利[9]。(Non-steroidal antiandrogens include flutamide, nilutamide, and bicalutamide, which do not lower androgen levels and may be favorable for individuals who want to preserve sex drive and fertility [9].)
传统上,建议患者在开始异性激素治疗之前冷冻保存精子,因为随着时间的推移,高剂量雌激素治疗可能会降低精子活力(Lubbert等,1992)。然而,由于研究有限,雌激素治疗导致的生育力下降仍有争议。(Traditionally, patients have been advised to cryopreserve sperm prior to starting cross-sex hormone therapy as there is a potential for a decline in sperm motility with high-dose estrogen therapy over time (Lubbert et al., 1992). However, this decline in fertility due to estrogen therapy is controversial due to limited studies.)
[...]在第一次注射亮丙瑞林之前进行雌激素或抗雄激素治疗可能会降低[治疗开始时由睾酮“爆发”引起的症状风险](16)。([...] estrogen or antiandrogen treatment prior to the first leuprolide injection may reduce [the risk of symptoms caused by the testosterone "flare" at the initiation of treatment] (16).)
[...]建议在为男性到女性的跨性别者开具口服非那雄胺的处方时要谨慎,因为该药物与诱发抑郁、焦虑和自杀意念有关,这些症状在性别不安患者中尤为常见,他们已经处于高风险中[9]。([...] caution is recommended while prescribing oral finasteride to male-to-female transsexuals, as the drug has been associated with inducing depression, anxiety and suicidal ideation, symptoms that are particularly common in patients with gender dysphoria, who are already at a high risk.[9])
在基质中,纤维和脂肪组织的数量增加,成人非哺乳期乳房由80%或更多的基质组成。(In the stroma, there is an increase in the amount of fibrous and fatty tissue, with the adult nonlactating breast consisting of 80% or more of stroma.)
在实验上,我已经能够诱导一名男性异装癖者的泌乳,该男性异装癖者的睾丸在几年前已被切除,其乳房在很长一段时间内使用芪雌酚和乙炔雌酮,发育已良好[9]。1955年7月9日,皮下植入600 mg雌二醇,每周注射50 mg孕酮,持续四个月。下个月每天注射10 mg二丙酸雌二醇和50 mg孕酮。这些注射又持续了一个月,将孕酮增加到每天100 mg。然后停用两种激素,逐日增加剂量注射催乳素和生长激素,持续四天;同时,患者每天使用吸乳器四次,每次5分钟。在此期间,乳腺静脉明显增大,在第六天和第七天收集到了1到2 mg乳状液体。(Experimentally I have been able to induce lactogenesis in a male transvestite whose testes had been removed some years before and whose breasts had been well developed over a long period with stilbestrol and ethisterone.9 In July, 1955, 600 mg. of estradiol was implanted subcutaneously and weekly injections of 50 mg. of progesterone were given for four months. For the next month daily injections of 10 mg. estradiol dipropionate and 50 mg. progesterone were given. These injections were continued for another month, increasing progesterone to 100 mg. daily. Both hormones were then withdrawn, and daily injections of increasing doses of prolactin and somatotropin were given for four days; at the same time, the patient used a breast bump four times daily for 5 minutes on both sides. During this time the mammary veins were visibly enlarged and on the sixth and seventh days 1 to 2 cc. of milky fluid was collected.)
Spironolactone is an aldosterone antagonist and a relatively weak antiandrogen that blocks the AR and inhibits androgen biosynthesis.
雌激素是下丘脑-垂体-睾丸轴的高效抑制剂(212-214)。除了它们在下丘脑和垂体水平的负反馈作用外,还可能对睾丸产生直接抑制作用(215,216)。[...][用雌激素治疗的]睾丸组织学显示曲细精管紊乱、空泡化和管腔缺失,以及精子发生的区室化。(Estrogens are highly efficient inhibitors of the hypothalamic-hypophyseal-testicular axis (212–214). Aside from their negative feedback action at the level of the hypothalamus and pituitary, direct inhibitory effects on the testis are likely (215,216). [...] The histology of the testes [with estrogen treatment] showed disorganization of the seminiferous tubules, vacuolization and absence of lumen, and compartmentalization of spermatogenesis.)
雌激素主要通过下丘脑-垂体水平的负反馈来减少LH分泌和睾丸雄激素合成。[...]有趣的是,如果不间断地暴露,3年后停止雌激素治疗,血清睾酮可能会保持在去势水平长达3年。这种长期抑制被认为是雌激素对睾丸间质细胞的直接影响所致。(Estrogens act primarily through negative feedback at the hypothalamic-pituitary level to reduce LH secretion and testicular androgen synthesis. [...] Interestingly, if the treatment with estrogens is discontinued after 3 yr. of uninterrupted exposure, serum testosterone may remain at castration levels for up to another 3 yr. This prolonged suppression is thought to result from a direct effect of estrogens on the Leydig cells.)
Therapy with GnRH analogs is expensive and requires intramuscular injections of depot formulations, the insert of a subcutaneous implant yearly, or, much less commonly, daily subcutaneous injections.
Treatment is expensive, with costs typically in the range of $10,000–$15,000 per year.
有人建议在每个雌激素治疗周期的最后一周添加孕激素,以形成更圆润的乳房,而不是这些患者中出现的锥形乳房,但我们无法检测到乳房轮廓在有没有孕激素情况下的差异。(It has been suggested that progestins be added during the last week of each cycle of estrogen therapy in order to develop more rounded breasts rather than the conical breasts many of these patients develop, but we have been unable to detect any difference in breast contour with or without progestins.)
雌激素刺激乳头生长,乳腺终末导管分支发展到形成导管的阶段,脂肪基质生长至构成乳房质量的约85%。[...]初潮前后,当末端导管分支形成多个盲囊芽时,乳腺小叶出现。这些效果是由于有孕酮存在。[...]完整的小泡发育通常仅在怀孕期间,在额外的孕酮和催乳素的影响下发生。(Estrogen stimulates the nipples to grow, mammary terminal duct branching to progress to the stage at which ductules are formed, and fatty stromal growth to increase until it constitutes about 85% of the mass of the breast. [...] Lobulation appears around menarche, when multiple blind saccular buds form by branching of the terminal ducts. These effects are due to the presence of progesterone. [...] Full alveolar development normally only occurs during pregnancy under the influence of additional progesterone and prolactin.)
在整个生育期,一些女性在月经开始前的每个月经周期后期都会注意到乳房肿胀。在月经周期的这个阶段,乳房组织的保水和随后的肿胀被认为是由于高水平的循环孕酮刺激了乳房的分泌细胞。(Throughout the reproductive years, some women note swelling of the breast around the latter part of each menstrual cycle before the onset of menstruation. The water retention and subsequent swelling of breast tissue during this phase of the menstrual cycle are thought to be due to high levels of circulating progesterone stimulating the secretory cells of the breast.12)
[...]进行了外生殖器去势和女性化整形手术[...]手术后一段时间,患者对生活重新产生了兴趣。经过手术和荷尔蒙矫正后,患者不可抗拒地发展出母性本能。未婚,患者获准领养孩子,模拟怀孕,带着儿子从妇产医院出院。从“出生”后的第一天开始,溢乳急剧增加,出现自发流出乳汁,伴溢乳(+++)。婴儿一直母乳喂养到6个月大。[...]我们的信息是文献中第二例有关男性易性症患者溢乳的描述。R.[Flückiger]等人于1983年首次描述了这种类型(6)。这一观察结果证明了泌乳发育机制与一个人的遗传性别相独立,并且对男性发生药物性溢乳的可能性感到担忧。([...] castration and feminizing plastic surgery of the external genitalia was performed [...] Some time after the operation, the patient developed a renewed interest in life. After the surgical and hormonal correction, the patient irresistibly developed maternal instincts. Unmarried, the patient obtained permission for the adoption of a child, simulated pregnancy, and was discharged from the maternity hospital with a son. From the first days after the “birth”, galactorrhea sharply increased, and spontaneous outflow of milk appeared, with galactorrhea (+++). The baby was breastfed up to 6 months of age. [...] Our message is the second in the world literature describing galactorrhea in a male patient with transsexualism. The first description of this kind was made in 1983 by R. [Flückiger] et al. (6). This observation demonstrates the independence of the mechanism of lactation development from one’s genetic sex and is alarming with regard to the possibility of drug-induced galactorrhea development in men.)
基于催乳理论,并受到Lyons、Li、Johnson&Cole[1955]在雄性大鼠中成功产生泌乳的激励,尝试在男性异装癖者中启动催乳。六年前,该患者接受了雌激素治疗。然后切除睾丸和阴茎,并通过整形手术构建人造阴道。该患者在1954年9月植入了500 mg雌二醇,在1955年7月植入了600 mg。然后每天注射二丙酸雌二醇和孕酮,持续6周,使乳房发育更加快速。停止该治疗后立即每天注射催乳素22·9 mg,连续3天无效。每天服用雌二醇和孕酮的第二个月后,联合注射催乳素和生长激素,持续4天,并通过吸乳器进行抽吸,每天4次。在第4天和第5天,从右侧乳头挤出几滴初乳。(Based on the theories of lactogenesis and stimulated by the success of Lyons, Li, Johnson & Cole [1955], who succeeded in producing lactation in male rats, an attempt was made to initiate lactogenesis in a male transvestist. Six years ago this patient had been given oestrogens. Both testes and penis were then removed and an artificial vagina was constructed by plastic surgery. The patient was implanted with 500 mg oestradiol in September 1954, and 600 mg in July 1955. The breasts were then developed more intensively with daily injections of oestradiol dipropionate and progesterone for 6 weeks. Immediately following withdrawal of this treatment, prolactin 22·9 mg was injected daily for 3 days without effect. After a second month on oestradiol and progesterone daily, combined injections of prolactin and somatotrophin were given for 4 days and suction was applied by a breast pump-four times daily. On the 4th and 5th days a few drops of colostrum were expressed from the right nipple.)
最近,Foss(1956)尝试在一名被阉割的男性异装癖者中开始哺乳。给他植入了500 mg的雌二醇,10个月后,又植入了600 mg的雌二醇,随后每天注射二丙酸雌二醇和黄体酮,持续6周。停药后立即每天注射22·9 mg催乳素,连续3天,但没有效果。在每天用雌二醇和黄体酮治疗的第二个月后,他被给予催乳素和生长激素联合注射4天,每天使用吸乳器抽吸4次。在第四天和第五天,从右侧乳头挤出几滴初乳。这是现代激素知识在男性中的一个可能应用,值得进一步试验。(Recently, an attempt has been made by Foss (1956) to initiate lactation in a castrated male transvestist. He was given an implant of 500 milligrams of oestradiol, and 10 months later, a further 600 milligrams of oestradiol, followed by daily injections of oestradiol dipropionate and progesterone for 6 weeks. Immediately after withdrawal of this treatment, 22·9 milligrams of prolactin were injected daily for 3 days but without effect. After a second month of treatment with oestradiol and progesterone daily, he was given combined injections of prolactin and somatotrophin for 4 days, suction with a breast-pump being employed 4 times daily. On the fourth and fifth days a few drops of colostrum were expressed from the right nipple. There is a possible application here of modern hormone knowledge to man, and further trials would be of interest.)
[...]对男性变性者的观察(Wyss和DelPozo未发表)表明,在人类男性中也可以类似地实现泌乳诱导。[...]([...] An observation (Wyss and Del Pozo unpublished) in a male transsexual showed that induction of lactation can be similarly achieved in the human male. [...])
仅仅2年后,温弗瑞进行的另一次采访,引发了许多观众相同的反应。在2010年的这一集中,女同性恋伙伴克里斯汀·麦金博士和丽莎·博茨抱着他们的双胞胎婴儿时喜极而泣。再一次,当人们发现美丽的克里斯汀是一位男到女变性人,曾经是一位英俊的军官克里斯时,观众的下巴都掉了下来,而丽莎使用克里斯汀在性别确认手术之前储存的精子生下了她们的亲生孩子[10]。当温弗瑞观看克里斯汀母乳喂养她们孩子的视频时,温弗瑞的下巴差点撞到地板上(这一集在网上称为“成为自己孩子父亲的妈妈”)。[...](Just 2 years later, Winfrey would feature another interview that elicited many of the same audience reactions. In this 2010 episode, lesbian partners Dr. Christine McGinn and Lisa Bortz beamed with joy as they held their infant twins. Again, audience members' jaws dropped when it was revealed that beautiful Christine was a male-to-female transsexual who used to be a handsome military officer Chris, and that Lisa had given birth to the couple's biological children using sperm Chris banked prior to gender confirmation surgeries.10 And it was Winfrey's chin that nearly hit the floor as she watched video of Christine breastfeeding the couples' children (the episode is referred to online as "The Mom Who Fathered Her Own Children"). [...])
传统上,建议患者在开始异性激素治疗之前冷冻保存精子,因为随着时间的推移,高剂量雌激素治疗可能会降低精子活力(Lubbert等,1992)。然而,由于研究有限,雌激素治疗导致的生育力下降仍有争议。(Traditionally, patients have been advised to cryopreserve sperm prior to starting cross-sex hormone therapy as there is a potential for a decline in sperm motility with high-dose estrogen therapy over time (Lubbert et al., 1992). However, this decline in fertility due to estrogen therapy is controversial due to limited studies.)
[...]进行了外生殖器去势和女性化整形手术[...]手术后一段时间,患者对生活重新产生了兴趣。经过手术和荷尔蒙矫正后,患者不可抗拒地发展出母性本能。未婚,患者获准领养孩子,模拟怀孕,带着儿子从妇产医院出院。从“出生”后的第一天开始,溢乳急剧增加,出现自发流出乳汁,伴溢乳(+++)。婴儿一直母乳喂养到6个月大。[...]我们的信息是文献中第二例有关男性易性症患者溢乳的描述。R.[Flückiger]等人于1983年首次描述了这种类型(6)。这一观察结果证明了泌乳发育机制与一个人的遗传性别相独立,并且对男性发生药物性溢乳的可能性感到担忧。([...] castration and feminizing plastic surgery of the external genitalia was performed [...] Some time after the operation, the patient developed a renewed interest in life. After the surgical and hormonal correction, the patient irresistibly developed maternal instincts. Unmarried, the patient obtained permission for the adoption of a child, simulated pregnancy, and was discharged from the maternity hospital with a son. From the first days after the “birth”, galactorrhea sharply increased, and spontaneous outflow of milk appeared, with galactorrhea (+++). The baby was breastfed up to 6 months of age. [...] Our message is the second in the world literature describing galactorrhea in a male patient with transsexualism. The first description of this kind was made in 1983 by R. [Flückiger] et al. (6). This observation demonstrates the independence of the mechanism of lactation development from one’s genetic sex and is alarming with regard to the possibility of drug-induced galactorrhea development in men.)