Louis Gooren

Martin Luther University Halle-Wittenberg | MLU · Centre for Reproduktive Medicine and Andrology

Background: Increased mortality in transgender people has been described in earlier studies. Whether this increased mortality is still present over the past decades is unknown. Therefore, we aimed to investigate trends in mortality over five decades in a large cohort of adult transgender people in addition to cause-specific mortality. Methods: W...

Context: Hormonal interventions in adolescents with gender dysphoria may have adverse effects such as reduced bone mineral accrual. Objective: To describe bone mass development in adolescents with gender dysphoria treated with gonadotropin-releasing hormone analogues (GnRHa), subsequently combined with gender affirming hormones. Design: Observ...

Context Trans women (male sex assigned at birth, female gender identity) mostly use anti-androgens combined with estrogens and can subsequently undergo vaginoplasty including orchiectomy. Because the prostate remains in situ after this procedure, trans women are still at risk for prostate cancer. Objective The incidence of prostate cancer in trans...

Background Testosterone has been implicated in suicidality in cross-sectional studies. Stress that coincides with a suicide attempt may alter androgen levels, so prospective studies are needed to exclude reverse causation. We aimed to examine the associations of plasma androgens with concurrent and future suicidality, and if so, whether these assoc...

In hypogonadal/postmenopausal individuals, hormone therapy has been associated with an increased risk for cardiovascular events (CVEs). A steeply growing population that often receives exogenous hormones is transgender individuals. Although transgender individuals hypothetically have an increased risk of CVEs, there is little known about the occurr...

High quality empirical data assessing morbidity and mortality and cancer incidence among transgender people are almost non-existent. Sex hormone treatment of conditions in older non-transgender people might as yet be taken as the best available analogy to hormone administration to aging transgender persons. Testosterone administration to transgende...

Gender affirming treatment for transgender people requires a multidisciplinary approach in which endocrinologists play a crucial role. The aim of this paper is to review recent data on hormonal treatment of this population and its effect on physical, psychological and mental health. The Endocrine Society guidelines for transgender women include est...

Benign brain tumours may be hormone sensitive. To induce physical characteristics of the desired gender, transgender individuals often receive cross-sex hormone treatment, sometimes in higher doses than hypogonadal individuals. To date, long-term (side) effects of cross-sex hormone treatment are largely unknown. In the present retrospective chart s...

It has been claimed that hyperestrogenism occurs in hypertrophic osteoarthropathy (HOA), but not in simple clubbing. However, one of our patients had simple clubbing and hyperestrogenism. We therefore measured estrogens, androgens, sex hormone-binding globulin (SHBG), and gonadotropins in five patients with HOA and in 18 patients with simple clubbi...

Background: Over the past decade, the number of people referred to gender identity clinics has rapidly increased. This raises several questions, especially concerning the frequency of performing gender-affirming treatments with irreversible effects and regret from such interventions. Aim: To study the current prevalence of gender dysphoria, how...

Objective To update the “Endocrine Treatment of Transsexual Persons: An Endocrine Society Clinical Practice Guideline,” published by the Endocrine Society in 2009. Participants The participants include an Endocrine Society–appointed task force of nine experts, a methodologist, and a medical writer. Evidence This evidence-based guideline was devel...

This observational post-marketing study of parenteral testosterone undecanoate (TU) in a non-selected population aimed to: examine the effectiveness of TU as treatment of hypogonadism; record adverse drug reactions (ADR) quantitatively particularly regarding polycythemia, prostate safety and cardiovascular-related metabolic risk factors; and verify...

Homosexual activity has been universal throughout history, but homosexuality as an orientation was recognized and its name was coined not earlier than 1869 by Kertbeny. The initial theoreticians of homosexuality were driven by the desire to emancipate homosexuals from oppression and believed that elucidation of the biological underpinnings would su...

With great interest and appreciation, we read about the additional analyses Drs. Mazur and Westerman have performed on the source data of our registry which we shared with them in pursuit of gaining further insight into potential mechanisms involved in the effectiveness of long-term testosterone therapy in hypogonadal men. This article is protected...

Sex hormones have been proposed as a possible risk factor for the development and growth of meningiomas. Hormonal therapy plays a fundamental role in the treatment of male-to-female transgenders and needs to be continued after sex reassignment surgery. Usually, this treatment leads to no adverse events; however, its impact on hormone-related tumour...

Aim: Variations in diagnosing and treating testosterone (T) deficiency between different regions of the world were analyzed in 2006, and repeated in 2010. At present, the changes since 2006 were analyzed. Methods: About 731 physicians were interviewed in Europe, South Africa, Central and South America regarding factors determining: (1) prescript...

In addition to primary and secondary ("classical") hypogonadism, hypogonadism, occurring in middle aged and elderly men has been recognized. There is evidence that restoring T levels to normal improves body weight, serum lipids and glucose levels. observational registry study. 262 hypogonadal, middle-aged and elderly, men received testosterone repl...

Psoriasis is increasingly recognised as a skin disease with far-reaching systemic effects, associated with a high prevalence of comorbid disease such as cardiometabolic dysfunction, shifting the focus from a single organ disease confined to the skin to a systemic inflammatory condition. Chronic and systemic inflammation plays a major role in the de...

Type 2 diabetes mellitus (T2DM) is often associated with obesity and subnormal serum testosterone (T) levels. Until 5 years ago there was no indication that men with type 1 diabetes mellitus (T1DM) had subnormal serum T. But recent studies indicate that about 10% of men with T1DM suffer from hypogonadism, as a rule aged men and men with obesity. Wh...

Crohn's disease is an inflammatory chronic bowel disease characterized by an imbalanced production of pro-inflammatory mediators (tumor necrosis factor-α) and an increased recruitment of leukocytes to the site of inflammation. Low serum testosterone is associated with an increase in inflammatory factors, while testosterone administration reduces th...

To investigate the potential benefits of testosterone administration to elderly men (>65 years) with late-onset hypogonadism (LOH) in comparison with younger men and to assess the safety of testosterone administration to elderly men. A total of 561 hypogonadal men from two registry studies were divided into age groups of ≤65 years (group Y, n=450;...

Cross-sex hormone treatment of transgender persons is usually uneventful, but hormone-sensitive malignancies of the (reproductive) organs of the natal and new sex (breasts, neovagina) may arise. Sex reassignment surgery impacts on the urodynamcis of the reassigned sex. Pathology originating from organ systems of the natal sex may be overlooked in t...

Cross-sex hormone treatment of transsexual people may be associated with the induction and growth stimulation of hormone-related malignancies. We report here five cases of breast cancer, three in female-to-male (FtoM) transsexual subjects and two in male-to-female (MtoF) transsexual subjects. In the general population the incidence of breast cancer...

There is a limited body of knowledge of desired and undesired effects of cross-sex hormones in transsexual people. Little attention has been given to the fact that chromosomal configurations, 46,XY in male-to-female transsexuals subjects (MtoF) and 46,XX in female-to-male transsexual subjects (FtoM), obviously, remain unchanged. These differences i...

There exists limited understanding of cross-sex hormone use and mental well-being among transgender women and, particularly, among transgender men. Moreover, most studies of transgender people have taken place in the Global North and often in the context of HIV. This exploratory study compared 60 transgender men (toms) with 60 transgender women (ka...

Guidelines for cross-sex hormone treatment of transsexual people have been developed, but no attention has been paid to the specifics of ethnic groups. South East (SE) Asian male-to-female (MtoF) transsexual people may be able to transition to the female sex with lower doses of estrogens/progestins than Caucasians thus reducing health risks. Female...

Male-to-female transsexual persons use oestrogens + antiandrogens to adapt their physical bodies to the female sex. Doses are usually somewhat higher than those used by hypogonadal women receiving oestrogen replacement. Particularly in cases of self-adminstration of cross-sex hormones, doses may be very high. Oestrogens are powerful stimulators of...

Some men between the ages 45 and 60 years develop complaints and symptoms reminiscent of menopausal complaints in women. So, parallels were sought between the changes in female and male endocrinology during that period of life. Indeed, men do show a decline of serum testosterone from age 40 to 50 years onwards but it is a slow decline of 1-2% per y...

Hormonal treatment of transgender people is becoming a normal part of medicine, though numbers of subjects remain small because of low prevalence. Information on treatment is scattered and this review brings together the latest information on treatment goals and potential side-effects of androgen treatment of female-to-male transsexual subjects. An...

Transgender people may wish to transition to the other sex, usually to the fullest extent possible. Part of that transition is enabled by the administration of cross-sex hormones and part by surgical adaptation. The treatment of male-to-female transgender people consists of blocking androgen action and allowing estrogens to feminize the body. For v...

Guidelines for cross-sex hormone treatment of transsexual people are now in place. However, little attention has been paid to the issue of treatment suitability for older people. Does existing treatment need to be adapted as subjects age, and does it make a difference if treatment is only started when the subject is already older? To assess the nec...

In trans women (male-to-female transsexual persons), cross-sex hormone therapy is administered to induce feminization. Breast development is an important part of feminization for most trans women. The aim of this study is to assess the effect of cross-sex hormone therapy on breast development in adult trans women. Additionally, we aimed to investig...

The incidence of heart disease increases with age, but is lower in women than in men up to 75 years. A protective effect of female sex hormones or, alternatively, acceleration in male heart disease by testosterone at younger ages, could explain this sex difference. In contrast with the above, male-to-female transsexual subjects (MtoF) treated with...

Testosterone deficiency leads to bone loss and testosterone treatment has a beneficial effect. This study investigated the effects of normalizing serum testosterone on bone mineral density in 45 men with osteoporosis, diagnosed with testosterone deficiency (serum testosterone levels < 12.1 nmol/L, T -scores: (mean ± SD) −3.12 ± 0.45, minimum: −4....

Male-to-female transsexual persons (MtoF) undergo treatment with antiandrogens and oestrogens followed by bilateral orchiectomy. The aim of this study was to investigate the incidence of prostate cancer (PCa) in a cohort of MtoF individuals. Medical records 2306 MtoF treated between 1975 and 2006 of the Amsterdam Gender Clinic were reviewed. Mean a...

Background Treatment of obesity with diet and exercise may have short-term success but longer-term maintenance of weight loss is less successful. Obesity is associated with a reduction of serum testosterone, and, vice versa, a reduction in serum testosterone is associated with obesity and features of the metabolic syndrome. Objective To investigat...

Introduction: Transsexual people receive cross-sex hormones as part of their treatment, potentially inducing hormone-sensitive malignancies. Aim: To examine the occurrence of breast cancer in a large cohort of Dutch male and female transsexual persons, also evaluating whether the epidemiology accords with the natal sex or the new sex. Main outc...

Administration of cross-sex hormones to male-to-female transsexual subjects, usually oestrogens + often anti-androgens, such as cyproterone acetate, carries a risk of venous thromboembolism (VTE). VTE usually occurs in the first year of oestrogen administration. Ethinyl oestradiol, due to its chemical structure, was in 2003 identified as a major fa...

Sexual differentiation in mammals is largely driven by the presence of androgen in males and their absence in females. The presence of androgens induces a number of irreversible changes in males: prenatally, the genital differentiation; during puberty, the development of secondary sex characteristics - the larger facial bones, hand, feet and height...

Transgender people sometimes use cross-sex hormones without medical supervision. The use of cross-sex hormones, as well as the functional health and mental well-being, among male-to-female transgendered people ('kathoeys') in Chiang Mai, Thailand, was studied. Sixty kathoeys were interviewed regarding their use of cross-sex hormones and their famil...

Three approaches have been used to make testosterone therapeutically effective: (1) routes of administration, (2) esterification in the 17β-position, and (3) chemical modification of the molecule or a combination of approaches. In clinical practice, particularly in the perception of the patient, the route of administration is most relevant and is u...

The etiology of premature ejaculation is not well understood (International Society for Sexual Medicine 2008; Waldinger 2007). From an etiological and therapeutic viewpoint, it is useful to distinguish between primary (lifelong, from the onset of sexual functioning) and secondary premature ejaculation (acquired after a period of normal sexual funct...

Androgens have a relatively long history of about 70 years since their characterization in the mid-1930s. This contribution tries to define and optimize their appropriate clinical use, to minimize their misuse, and to avoid their abuse.

In the early 1960s, when the “sexual revolution” took off, it seemed that sexually transmitted diseases were of no great concern anymore. There was effective antibiotic treatment which led also to a degree of carelessness among people who engaged in casual sexual encounters. The sequelae of a sexually transmitted disease were no longer the price to...

Abstract Background: The ATPIII criteria of the metabolic syndrome (MS) comprise impaired fasting glucose (>5.6 nmol/L), waist circumference >102 cm, hypertension (>130/85 mm Hg), high triglycerides (>1.7 nmol/L) and low HDL cholesterol (≤1.03 nmol/L). Aldosterone is currently recognized as a key factor in the pathogenesis of cardiovascular disease...

Introduction: The clinical significance of low to low-normal testosterone (T) levels in men remains debated. Aim: To analyze the effects of raising serum T on lean body mass (LBM), fat mass (FM), total body mass, and health-related quality-of-life (HRQoL). Methods: Randomized, double-blind, placebo-controlled study. Men, aged 50-80 years, with...

Introduction. Morbidity/mortality is higher in men with below-normal serum testosterone. Restoring testosterone to normal is beneficial. Aim. Assessment of safety and effectiveness of injectable long-acting testosterone undecanoate (TU) in hypogonadal men in daily clinical practice. Methods. An international, multicenter, one-arm, prospective obser...

An analysis of variations in diagnosing and treating testosterone (T) deficiency between different regions of the world in 2006 was repeated in 2010. Physicians were interviewed in Germany, Spain, the United Kingdom, Brazil and Saudi Arabia about (1) reasons to use/not to use T. (2) safety (prostate pathology) and other concerns in the decision not...

Obesity negatively affects human health. Limiting food intake, while producing some weight loss, results in reduction of lean body mass. Combined with moderate exercise it produces significant weight loss, maintains lean body mass and improves insulin sensitivity, but appears difficult to adhere to. Bariatric surgery is clinically effective for sev...

Blood testosterone codetermines the threshold for erotosexual imagery and sexual activity. Androgen deprivation may therefore have a place in the treatment of unacceptable sexual behavior. Although androgen deprivation can be effective for sex offenders, their basic human rights must be respected; otherwise such treatment constitutes a violation of...

Testosterone has a spectrum of effects on the male organism. This review attempts to determine, from published studies, the time-course of the effects induced by testosterone replacement therapy from their first manifestation until maximum effects are attained. Literature data on testosterone replacement. Effects on sexual interest appear after 3 w...

Manhood and womanhood, and all shades in between, are part of medicine. While solutions are mostly technical and based on insights into biomedical science, issues inmedical care arise that cannot currently be satisfactorily solved on the basis of biomedical science alone. Disorders of sexual differentiation and the phenomenon of transsexualism requ...

Life expectancy is on average 7 years shorter for men than for women; from birth through senescence, death rates are higher for males than for females (1). Potentially contributing factors are male risk-taking behaviour (accidents, homicide, smoking, alcoholism, high professional and social achievement), less use of medical care, and possibly genet...

Parenchymal and stromal cells with the potential for normal breast development are equally present in prepubertal boys and girls. Men and women do not differ in sensitivity to the hormonal action of sex steroids, and therefore men have the same potential to develop breasts as women. Whether this actually occurs obviously depends on a person’s hormo...

Transsexualism is the condition in which a person with apparently normal somatic sexual differentiation is convinced that he/she is actually a member of the opposite sex. It is associated with an irresistible urge to be hormonally and surgically adapted to that sex. Traditionally transsexualism has been conceptualized as a purely psychological phen...

The traditional assumption that the prostate is an organ exquisitely sensitive to androgen action still holds true, but with lower-than-normal circulating levels of testosterone, all androgen receptors are saturated and a further increase in circulating levels of testosterone has no effect on the prostate (saturation model). Prostate disease (prost...

Testosterone administration to hypogonadal men improves the metabolic syndrome. This study analyzed whether age, serum testosterone, body mass index/waist circumference, increment in testosterone values and C-reactive protein (CRP) predicted the outcome of testosterone administration. A total of 110 mainly elderly men, aged between 18 and 83 years...

Adverse effects of long-term cross-sex hormone administration to transsexuals are not well documented. We assessed mortality rates in transsexual subjects receiving long-term cross-sex hormones. A cohort study with a median follow-up of 18.5 years at a university gender clinic. Methods Mortality data and the standardized mortality rate were compare...

In this review we identify whether problems encountered in urology, such as erectile dysfunction, have a bearing on general health, in particular cardiovascular health. Testosterone, traditionally regarded as the hormone subserving male reproductive and sexual functioning, appears to have a much wider role. Recent findings show that testosterone is...

T h e n e w e ng l a n d j o u r na l o f m e dic i n e n engl j med 364;13 nejm.org march 31, 2011 1251 This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author's cli...

Late onset hypogonadism was originally perceived as an academic topic. In the course of two decades it has become an issue impacting on everyday urology. For long time clinical conditions, such as cardiovascular disease, diabetes mellitus type 2, sexual dysfunction and urological complaints affecting the aging male, were regarded as independent cli...

Obesity has become a major health problem. Testosterone plays a significant role in obesity, glucose homeostasis, and lipid metabolism. The metabolic syndrome is a clustering of risk factors predisposing to diabetes mellitus type 2, atherosclerosis, and cardiovascular morbidity and mortality. The main components of the syndrome are visceral obesity...

Introduction Low testosterone levels in men are associated with the metabolic syndrome (MetS) as well as with depressive symptoms, low vitality and sexual dysfunction. Objectives To assess the effects of testosterone administration on these subjective symptoms, which have not extensively been studied in hypogonadal men with the MetS. Method In a...

This study investigated the safety of administration of long-acting parenteral testosterone undecanoate (TU) to 122 hypogonadal, mainly elderly men, aged 59.6 ± 8.0 years (range 18-83 years old), with baseline testosterone levels between 5.8 and 12.1 nmol l(-1) (mean ± SD = 9.3 ± 1.7). Patients were followed for 24 months. Plasma testosterone rose...

Men with the metabolic syndrome (MetS) have low plasma testosterone (T) levels. The aim of this study was to establish whether the normalization of plasma T improves the features of the MetS. A randomized, placebo-controlled, double-blinded, phase III trial of 184 men suffering from both the MetS and hypogonadism. One hundred and eighty-four men, a...