The impact of long-term testosterone replacement therapy on lipid and lipoprotein profiles in women.

The lipid and lipoprotein profiles of 39 female transsexuals, exposed to testosterone esters (250 mg monthly) for an average duration of 33 months after their sex reassignment operation (group 2), were compared to those of 29 normal menstruating female transsexuals prior to starting androgen therapy (group 1). A third group, comprising 17 post-operative female transsexuals were studied while on, and after stopping their androgen therapy for 6-12 months (group 3). The average concentration of testosterone in androgenized women was comparable to those found in normal males and levels of SHBG were significantly lower than those in the control group. No significant difference was noted between all levels of lipids and lipoproteins in pre-operative subjects of group 1 and corresponding levels in subjects of group 3 after they had stopped their androgen therapy for 6-12 months. Significantly higher levels of triglyceride (Trig), total cholesterol (TC), low-density lipoprotein (LDL-C) and apolipoprotein-B (Apo B) and a significantly lower level of high-density lipoprotein-cholesterol (HDL-C) were noted in androgenized women (group 2) when compared to controls (group 1). The two atherogenic indices, LDL-C/HDL-C and Apo-AI/Apo-B were significantly raised and lowered, respectively. Similar results were noted when comparing lipid and lipoprotein profiles in subjects of group 3 while they were on and after stopping their androgen therapy. Results from this study indicate that testosterone, per se, at supraphysiological doses may promote atherogenicity in women. Furthermore, the male predilection for coronary vascular diseases (CVD) may be due to the adverse effects of higher androgen levels on lipid and lipoprotein profiles.