Archives of Sexual Behavior, Vol. 8, No. 1, 1979
Plasma Testosterone, Serum FSH, and Serum LH Levels in Transvestism N. Buhrich, M.B., B.S., D.P.M., M.R.C. Psych., M.D., 1,3 H. Theile, M.Sc., 2 A. Yaw, M.Sc., 2 and A. Crawford, B . S c .
2
Plasma testosterone, serum FSH, and serum L H levels o f 26 members o f a club established for heterosexual transvestites were assayed. Mean plasma testosterone, serum FSH, and serum LH levels o f the transvestite subjects were not significantly different from the normal range. The implications o f these findings are discussed. KEY WORDS: transvestism; plasma testosterone; FSH levels; LH levels; sex hormones;
sexuality; gonadotropins.
INTRODUCTION There are no systematic reports of testosterone or gonadotropin levels in transvestite subjects. Starka et al. (1975) found the mean plasma testosterone levels of three transvestite patients to be significantly lower than those of norreal controls. Housden (1965) reviewed endocrine investigations in the published literature o f a sample o f 21 transvestite and transsexual subjects. Two had an unusually high o u t p u t o f female hormones. Transvestism is a syndrome in which subjects gain significant emotional relief from cross-dressing. Almost invariably they have shown a period o f fetish-
This work was supported by the National Health and Medical Research Council of Australia. 1Research Fellow, New South Wales Institute of Psychiatry, Rozelle, New South Wales, 2039, Australia. 2Endocrinology Department, Prince of Wales Hospital, Randwick, New South Wales, 2031, Australia. Address correspondence to Dr. N. Buhrich, Staff Psychiatrist, St. Vincent's Hospital, Darlinghurst, N.S.W., 2010, Australia. 49 0004-0002/79/0100-0049503.00/0 © 1979 Plenum Publishing Corporation
50
Buhrich, Theile, Yaw, and Crawford
istic arousal to women's clothes. Most "live and work as men and lead normal heterosexual lives, often as husbands and fathers" (Benjamin, 1966). The term "femmiphilic transvestism," to describe the subjects' love of feminine things, has been coined for the syndrome by Prince (Prince and Bentler, 1972). The report which follows concerns members of a club established for heterosexual transvestites. When cross-dressed, apart from speaking in their normal masculine voice, members imitate women as closely as possible. No attempt is made to parody women, and no overt sexual interest in other members is displayed at meetings. The club is described elsewhere (Buhrich, 1976).
METHODOLOGY
Subjects and Interview Procedure Club members were asked to participate in a project concerning transvestism. Thirty dollars was offered to each volunteer. Thirty-five transvestite subjects volunteered for interview. All were male. There were six transvestites who had taken female homones in the previous 3 months. These six and a further two subjects, who refused venipuncture, were excluded from the study. The blood sample of one subject hemolyzed before it reached the laboratory. The hormone levels of the remaining 26 subjects were assayed. The mean age of the 26 subjects was 38.9 years (range 21-69). Twenty were currently married and one was living in a de facto relationship. Data were collected during a 4-hr interview. Biographical information and sexual history were recorded. During the interview, one of us (N.B.) rated the subject's sexual orientation using the Kinsey scale. On this scale, the maximum heterosexual score is 0 and the maximum homosexual score is 6. Tissues from buccal scrapings were examined to determine the subject's chromosome constitution. Penile volume responses to moving pictures of nude men and women were scored for each subject and a U score was calculated. Using this method, the maximum heterosexual score is 100 and the maximum homosexual score is 0. The method is described elsewhere (McConaghy, 1967). Since the viewing of sexually explicit movies may increase serum testosterone levels (Pirke etal., 1974), subjects viewed the moving pictures of nude men and women after samples had been collected. Serum LH, serum FSH, and plasma testosterone levels of the transvestite subjects were compared with those in 22 control subjects. The control subjects included three research workers, eight staff members of the endocrine laboratory, and 11 of their friends. There was no indication that any of these subjects was not heterosexual, although none was specifically asked. Their mean age was
Sex Hormone Levels in Transvestism
51
27.7 years (range 20--43). Ten were married and two were living in a de f a c t o relationship. Method of Hormone Estimation
Serum luteinizing hormone (LH) was estimated according to the method of Albert et al. (1968). The coefficient of variation was 12%, with a sensitivity of 3.1 ng. Serum follicle-stimulating hormone (FSH) was measured according to the method of Midgley (1967) using a Serono FSH kit code 1103. The coefficient of variation was 15% and the sensitivity was 0.4 mIU. Plasma testosterone was estimated by the method of Coyotupa e t al. (1972) with modification to the elution from the celite column by Thorneycroft e t al. (1973). The coefficient of variation was 10% and the sensitivity was 6 pg. Using the above methods, the normal hormone level ranges for the laboratory are serum LH 16-86 ng/ml (mean 35 -+ 18 ng/ml), serum FSH 2 - 1 6 mlU/ml (Midgley, 1967), and plasma testosterone 263-980 ng/100 ml (mean 583 --+201 ng/100 ml). The effect of diurnal rhythm (Southren et al., 1965 ; Resko and Eik-Ness, 1966) was minimized by collecting blood samples from each subject between 11 a.m. and 12 noon.
RESULTS
The results of serum FSH, serum LH, plasma testosterone, Kinsey scale rating, U score, and chromosome constitution for the transvestite subjects are listed in Table I in relation to the subject's age. There was no significant difference in mean plasma testosterone, serum FSH, and serum LH levels between the normal controls and transvestite subjects. As can be seen from Table I, six transvestite subjects had serum FSH levels above the upper limit of normal. The mean plasma testosterone level for the six was 483 ng/100 ml (range 225-774). Seven transvestite subjects had serum LH levels slightly below the lower limit of normal. Their mean plasma testosterone level was 498 ng/100 ml (range 136-907). Mean plasma testosterone levels for subjects with serum FSH levels above and serum LH levels below normal were 54 ng/100 ml and 36 ng/100 ml, respectively, below the mean level for the remaining transvestite subjects. These differences were not significant. The U scores calculated from measurements of the subjects' penile volume changes support the Kinsey scale rating of sexual orientation and indicate that the subjects show a greater heterosexual than homosexual interest. Nine transvestite subjects who were rated not "entirely heterosexual" on the Kinsey scale had a mean plasma testosterone level of 637 ng/100 ml (range
Btthrich, Theile, Yaw, and Crawford
52
Table I. CharacteIistics of Transvestite Subjects (N = 26) Age of subject (yr)
Serum FSH (normal range 2-16 mlU/ml)
Serum LH (normal range 1 6 - 8 6 ng/ml)
21 27 27 30 31
8 8 23 a 5 14
47 14 a 62 10 a 33
33 33 34 34 37 38
8 6 10 8 11 18 a
14 a 39 46 76 100 a 12 a
39 40 40 42 42 42
7 5 8 74 a 5 10
43 43 43 44 48 48 56 57 69
Plasma testosterone (normal range 2 6 3 - 9 8 0 ng/100 ml)
Kinsey scale rating (range 0 ~ 6 )
U score
Chromosome constitution
730 513 384 907 967
1 2 0 1 2
57.5 98,5 94 83 78
XY XY XY XY XY
540 430 450 544 415 530
0 0 1 0 3 0
82 96 69 59.5 64 58
XY XY XY XY XY XY
55 34 14 a 19 13 a 52
679 582 262 a 606 596 437
1 0 0 3 0 0
92 66 81.5 56.5 84 81,5
XY XY XY XYY Not done XY
40 a 19 a 9 7 14 9 25 a 12 8
130 a 54 21 21 29 72 22 12 a 42
774 380 469 265 530 288 225 a 136 a 1021 a
0 0 2 0 0 0 0 0 0
Mean = 14.3 (SD ± 14.5)
Mean = 38.9 (SD + 29.9)
Mean = 524.4 (SD ± 223)
79 50 Not done 62 93.5 93.5 72 72 66
Not done XY Not done XY XY XY XY XY XY
Mean = 75.6 (SD +- 14.3)
a Serum levels outside normal range.
4 1 5 - 9 6 7 ) . This was slightly but not significantly higher than the mean testosterone level for the remaining transvestite subjects.
DISCUSSION
The mean plasma testosterone, serum FSH, and serum LH levels o f the transvestite subjects reported in this study were not significantly different from those o f normal controls. Testosterone levels in adult transvestite subjects give no indication of the level of serum testosterone levels during formative years (Yalom et al., 1973; Reinisch, 1974). The possibility that endocrine levels in utero play a role in the etiology of transvestism cannot be excluded.
ACKNOWLEDGMENTS
We are indebted to Professors McConaghy and Steinbeck for their assistance, to the Endocrinology Department, Prince of Wales Hospital, New South
Sex Hormone Levels in Transvestism
53
Wales, for use o f m a t e r i a l s , a n d to the P a t h o l o g y D e p a r t m e n t , Prince o f Wales Hospital, New S o u t h Wales, for assessing c h r o m o s o m e c o n s t i t u t i o n . We t h a n k t h e m e m b e r s o f t h e Seahorse Club for t h e i r c o o p e r a t i o n .
REFERENCES Albert, A., Rosenberg, E., Ross, G. T., et al. (1968). Report of the national pituitary agency collaborative study on the radioimmunoassay of FSH and LH. J. Clin. Endocrinol. 28: 1214. Benjamin, H. (1966). The TranssexualPhenomenon, Julian Press, New York. Buhrich, N. (1976). A heterosexual transvestite club: Psychiatric aspects. Aust. N . Z d. Psychiat. 10: 331-336. Coyotupa, J., Parlow, A. F., and Abraham, C. E. (1972). Simultaneous radioimmunoassay of plasma testosterone and dihydrotestosterone. Analyst. Lett. 5 : 329-340. Housden, J. An examination of the biologic aetiology of transvestism. Intern. J. Soc. Psychiat. 11: 301-305. McConaghy, N. (1967). Penile volume change to moving pictures of male and female nudes in heterosexual and homosexual subjects. Behav. Res. Ther. 5: 43-48. Midgley, A. R. (1967). Radioimmunoassay for human follicle stimulating hormone. Y. Clin. Endocrinol. 27: 295-299. Pirke, K. M., Kockott, G., and Dittmar, F. (1974). Psychosexual stimulation and plasma testosterone in man. Arch. Sex. Behav. 3: 577-584. Prince, V., and Bentler, P. M. (1972). Survey of 504 cases of transvestism. Psyehol. Rep. 31: 903-917. Reinisch, J. M. (1974). Fetal hormones, the brain and human sex differences: A heuristic, integrative review of the recent literature. Arch. Sex. Behav. 3:51-91. Resko, J. A., and Eik-Nes, K. B. (1966). Diurnal testosterone levels in peripheral plasma of human male subjects. J. Clin. Endocrinol. Metab. 126: 573-576. Southren, A. L., Techimoto, S., Carmody, N. C., et al. (1965). Plasma production rates of testosterone in normal adult men and women and in patients with the syndrome of feminizing testes. J. Clin. Endocrinol. Metab. 25: 1441-1450. Starka, L., Sipova, I., and Bynie, J. (1975). Plasma testosterone in male transsexuals and homosexuals. J. Sex Res. 11 : 134-138. Thorneycroft, I. H., Ribeiro,W. O., Stoner, S. C., and Tilison, S. A. (1973). A radioimmunoassay of androstenedione. Steroids 21:111-122. Yalom, I. D., Green, R., and Fisk, N. (1973). Prenatal exposure to female hormones: Effect on psychosexual development in boys. Arch. Gen. Psychol. 28: 554-562.
Plasma Testosterone, Serum FSH, and Serum LH Levels in Transvestism N. Buhrich, M.B., B.S., D.P.M., M.R.C. Psych., M.D., 1,3 H. Theile, M.Sc., 2 A. Yaw, M.Sc., 2 and A. Crawford, B . S c .
2
Plasma testosterone, serum FSH, and serum L H levels o f 26 members o f a club established for heterosexual transvestites were assayed. Mean plasma testosterone, serum FSH, and serum LH levels o f the transvestite subjects were not significantly different from the normal range. The implications o f these findings are discussed. KEY WORDS: transvestism; plasma testosterone; FSH levels; LH levels; sex hormones;
sexuality; gonadotropins.
INTRODUCTION There are no systematic reports of testosterone or gonadotropin levels in transvestite subjects. Starka et al. (1975) found the mean plasma testosterone levels of three transvestite patients to be significantly lower than those of norreal controls. Housden (1965) reviewed endocrine investigations in the published literature o f a sample o f 21 transvestite and transsexual subjects. Two had an unusually high o u t p u t o f female hormones. Transvestism is a syndrome in which subjects gain significant emotional relief from cross-dressing. Almost invariably they have shown a period o f fetish-
This work was supported by the National Health and Medical Research Council of Australia. 1Research Fellow, New South Wales Institute of Psychiatry, Rozelle, New South Wales, 2039, Australia. 2Endocrinology Department, Prince of Wales Hospital, Randwick, New South Wales, 2031, Australia. Address correspondence to Dr. N. Buhrich, Staff Psychiatrist, St. Vincent's Hospital, Darlinghurst, N.S.W., 2010, Australia. 49 0004-0002/79/0100-0049503.00/0 © 1979 Plenum Publishing Corporation
50
Buhrich, Theile, Yaw, and Crawford
istic arousal to women's clothes. Most "live and work as men and lead normal heterosexual lives, often as husbands and fathers" (Benjamin, 1966). The term "femmiphilic transvestism," to describe the subjects' love of feminine things, has been coined for the syndrome by Prince (Prince and Bentler, 1972). The report which follows concerns members of a club established for heterosexual transvestites. When cross-dressed, apart from speaking in their normal masculine voice, members imitate women as closely as possible. No attempt is made to parody women, and no overt sexual interest in other members is displayed at meetings. The club is described elsewhere (Buhrich, 1976).
METHODOLOGY
Subjects and Interview Procedure Club members were asked to participate in a project concerning transvestism. Thirty dollars was offered to each volunteer. Thirty-five transvestite subjects volunteered for interview. All were male. There were six transvestites who had taken female homones in the previous 3 months. These six and a further two subjects, who refused venipuncture, were excluded from the study. The blood sample of one subject hemolyzed before it reached the laboratory. The hormone levels of the remaining 26 subjects were assayed. The mean age of the 26 subjects was 38.9 years (range 21-69). Twenty were currently married and one was living in a de facto relationship. Data were collected during a 4-hr interview. Biographical information and sexual history were recorded. During the interview, one of us (N.B.) rated the subject's sexual orientation using the Kinsey scale. On this scale, the maximum heterosexual score is 0 and the maximum homosexual score is 6. Tissues from buccal scrapings were examined to determine the subject's chromosome constitution. Penile volume responses to moving pictures of nude men and women were scored for each subject and a U score was calculated. Using this method, the maximum heterosexual score is 100 and the maximum homosexual score is 0. The method is described elsewhere (McConaghy, 1967). Since the viewing of sexually explicit movies may increase serum testosterone levels (Pirke etal., 1974), subjects viewed the moving pictures of nude men and women after samples had been collected. Serum LH, serum FSH, and plasma testosterone levels of the transvestite subjects were compared with those in 22 control subjects. The control subjects included three research workers, eight staff members of the endocrine laboratory, and 11 of their friends. There was no indication that any of these subjects was not heterosexual, although none was specifically asked. Their mean age was
Sex Hormone Levels in Transvestism
51
27.7 years (range 20--43). Ten were married and two were living in a de f a c t o relationship. Method of Hormone Estimation
Serum luteinizing hormone (LH) was estimated according to the method of Albert et al. (1968). The coefficient of variation was 12%, with a sensitivity of 3.1 ng. Serum follicle-stimulating hormone (FSH) was measured according to the method of Midgley (1967) using a Serono FSH kit code 1103. The coefficient of variation was 15% and the sensitivity was 0.4 mIU. Plasma testosterone was estimated by the method of Coyotupa e t al. (1972) with modification to the elution from the celite column by Thorneycroft e t al. (1973). The coefficient of variation was 10% and the sensitivity was 6 pg. Using the above methods, the normal hormone level ranges for the laboratory are serum LH 16-86 ng/ml (mean 35 -+ 18 ng/ml), serum FSH 2 - 1 6 mlU/ml (Midgley, 1967), and plasma testosterone 263-980 ng/100 ml (mean 583 --+201 ng/100 ml). The effect of diurnal rhythm (Southren et al., 1965 ; Resko and Eik-Ness, 1966) was minimized by collecting blood samples from each subject between 11 a.m. and 12 noon.
RESULTS
The results of serum FSH, serum LH, plasma testosterone, Kinsey scale rating, U score, and chromosome constitution for the transvestite subjects are listed in Table I in relation to the subject's age. There was no significant difference in mean plasma testosterone, serum FSH, and serum LH levels between the normal controls and transvestite subjects. As can be seen from Table I, six transvestite subjects had serum FSH levels above the upper limit of normal. The mean plasma testosterone level for the six was 483 ng/100 ml (range 225-774). Seven transvestite subjects had serum LH levels slightly below the lower limit of normal. Their mean plasma testosterone level was 498 ng/100 ml (range 136-907). Mean plasma testosterone levels for subjects with serum FSH levels above and serum LH levels below normal were 54 ng/100 ml and 36 ng/100 ml, respectively, below the mean level for the remaining transvestite subjects. These differences were not significant. The U scores calculated from measurements of the subjects' penile volume changes support the Kinsey scale rating of sexual orientation and indicate that the subjects show a greater heterosexual than homosexual interest. Nine transvestite subjects who were rated not "entirely heterosexual" on the Kinsey scale had a mean plasma testosterone level of 637 ng/100 ml (range
Btthrich, Theile, Yaw, and Crawford
52
Table I. CharacteIistics of Transvestite Subjects (N = 26) Age of subject (yr)
Serum FSH (normal range 2-16 mlU/ml)
Serum LH (normal range 1 6 - 8 6 ng/ml)
21 27 27 30 31
8 8 23 a 5 14
47 14 a 62 10 a 33
33 33 34 34 37 38
8 6 10 8 11 18 a
14 a 39 46 76 100 a 12 a
39 40 40 42 42 42
7 5 8 74 a 5 10
43 43 43 44 48 48 56 57 69
Plasma testosterone (normal range 2 6 3 - 9 8 0 ng/100 ml)
Kinsey scale rating (range 0 ~ 6 )
U score
Chromosome constitution
730 513 384 907 967
1 2 0 1 2
57.5 98,5 94 83 78
XY XY XY XY XY
540 430 450 544 415 530
0 0 1 0 3 0
82 96 69 59.5 64 58
XY XY XY XY XY XY
55 34 14 a 19 13 a 52
679 582 262 a 606 596 437
1 0 0 3 0 0
92 66 81.5 56.5 84 81,5
XY XY XY XYY Not done XY
40 a 19 a 9 7 14 9 25 a 12 8
130 a 54 21 21 29 72 22 12 a 42
774 380 469 265 530 288 225 a 136 a 1021 a
0 0 2 0 0 0 0 0 0
Mean = 14.3 (SD ± 14.5)
Mean = 38.9 (SD + 29.9)
Mean = 524.4 (SD ± 223)
79 50 Not done 62 93.5 93.5 72 72 66
Not done XY Not done XY XY XY XY XY XY
Mean = 75.6 (SD +- 14.3)
a Serum levels outside normal range.
4 1 5 - 9 6 7 ) . This was slightly but not significantly higher than the mean testosterone level for the remaining transvestite subjects.
DISCUSSION
The mean plasma testosterone, serum FSH, and serum LH levels o f the transvestite subjects reported in this study were not significantly different from those o f normal controls. Testosterone levels in adult transvestite subjects give no indication of the level of serum testosterone levels during formative years (Yalom et al., 1973; Reinisch, 1974). The possibility that endocrine levels in utero play a role in the etiology of transvestism cannot be excluded.
ACKNOWLEDGMENTS
We are indebted to Professors McConaghy and Steinbeck for their assistance, to the Endocrinology Department, Prince of Wales Hospital, New South
Sex Hormone Levels in Transvestism
53
Wales, for use o f m a t e r i a l s , a n d to the P a t h o l o g y D e p a r t m e n t , Prince o f Wales Hospital, New S o u t h Wales, for assessing c h r o m o s o m e c o n s t i t u t i o n . We t h a n k t h e m e m b e r s o f t h e Seahorse Club for t h e i r c o o p e r a t i o n .
REFERENCES Albert, A., Rosenberg, E., Ross, G. T., et al. (1968). Report of the national pituitary agency collaborative study on the radioimmunoassay of FSH and LH. J. Clin. Endocrinol. 28: 1214. Benjamin, H. (1966). The TranssexualPhenomenon, Julian Press, New York. Buhrich, N. (1976). A heterosexual transvestite club: Psychiatric aspects. Aust. N . Z d. Psychiat. 10: 331-336. Coyotupa, J., Parlow, A. F., and Abraham, C. E. (1972). Simultaneous radioimmunoassay of plasma testosterone and dihydrotestosterone. Analyst. Lett. 5 : 329-340. Housden, J. An examination of the biologic aetiology of transvestism. Intern. J. Soc. Psychiat. 11: 301-305. McConaghy, N. (1967). Penile volume change to moving pictures of male and female nudes in heterosexual and homosexual subjects. Behav. Res. Ther. 5: 43-48. Midgley, A. R. (1967). Radioimmunoassay for human follicle stimulating hormone. Y. Clin. Endocrinol. 27: 295-299. Pirke, K. M., Kockott, G., and Dittmar, F. (1974). Psychosexual stimulation and plasma testosterone in man. Arch. Sex. Behav. 3: 577-584. Prince, V., and Bentler, P. M. (1972). Survey of 504 cases of transvestism. Psyehol. Rep. 31: 903-917. Reinisch, J. M. (1974). Fetal hormones, the brain and human sex differences: A heuristic, integrative review of the recent literature. Arch. Sex. Behav. 3:51-91. Resko, J. A., and Eik-Nes, K. B. (1966). Diurnal testosterone levels in peripheral plasma of human male subjects. J. Clin. Endocrinol. Metab. 126: 573-576. Southren, A. L., Techimoto, S., Carmody, N. C., et al. (1965). Plasma production rates of testosterone in normal adult men and women and in patients with the syndrome of feminizing testes. J. Clin. Endocrinol. Metab. 25: 1441-1450. Starka, L., Sipova, I., and Bynie, J. (1975). Plasma testosterone in male transsexuals and homosexuals. J. Sex Res. 11 : 134-138. Thorneycroft, I. H., Ribeiro,W. O., Stoner, S. C., and Tilison, S. A. (1973). A radioimmunoassay of androstenedione. Steroids 21:111-122. Yalom, I. D., Green, R., and Fisk, N. (1973). Prenatal exposure to female hormones: Effect on psychosexual development in boys. Arch. Gen. Psychol. 28: 554-562.
