H Asscheman's research while affiliated with Hogeschool Utrecht and other places

Publications (56)

Book
Full-text available
De afgelopen jaren is de potentieel vermijdbare sterfte in ziekenhuizen niet verder gedaald. Tussen half 2015 en half 2016 overleden circa 1.035 patiënten door zorggerelateerde schade die waarschijnlijk voorkomen had kunnen worden. Eerder was deze potentieel vermijdbare sterfte in ziekenhuizen sterk gedaald, onder andere door de invoering van het V...
Chapter
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...
Article
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...
Data
The Institute for Healthcare Improvement (IHI) Adverse Drug Event Trigger Tool as modified to the Dutch hospital setting. *Antiemetics: alizapride, domperidone, droperidol, metoclopramide, prochlorperazine, ondansetron, granisetron, palonosetron, tropisetron, aprepitant, fosaprepitant **Anti-diarrheal drugs: loperamide, activated charcoal (mostly u...
Article
Full-text available
Background: Older patients are at high risk for experiencing Adverse Drug Events (ADEs) during hospitalization. To be able to reduce ADEs in these vulnerable patients, hospitals first need to measure the occurrence of ADEs, especially those that are preventable. However, data on preventable ADEs (pADEs) occurring during hospitalization in older pat...
Article
Full-text available
Objective To determine the change in adverse event (AE) rates and preventable AE rates over time, identify certain patient risk groups and discuss factors influencing the outcome. Design Longitudinal retrospective patient record review study. Setting and participants A random sample of 21 hospitals in The Netherlands in 2004, and 20 hospitals in 20...
Article
Full-text available
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...
Article
Full-text available
Medication-related adverse events (MRAEs) form a large proportion of all adverse events in hospitalized patients and are associated with considerable preventable harm. Detailed information on harm related to drugs administered during hospitalization is scarce. Knowledge of the nature and preventability of MRAEs is needed to prioritize and improve m...
Article
Background: Medication-related adverse events (MRAEs) form a large proportion of all adverse events in hospitalized patients and are associated with considerable preventable harm. Detailed information on harm related to drugs administered during hospitalization is scarce. Knowledge of the nature and preventability of MRAEs is needed to prioritize a...
Article
Histomorphometry was performed in iliac crest biopsies from 15 female-to-male (F-M) transsexuals with a mean age of 30 +/- 6.1 (SD) years. At the time of study, they had been treated with parenteral testosterone esters (250 mg/2 weeks) or oral testosterone undecanoate (160 mg/day). The median androgen treatment duration was 39 months. The patients...
Article
Full-text available
Up to now, costs attributable to adverse events (AEs) and preventable AEs in the Netherlands were unknown. We assessed the total direct medical costs associated with AEs and preventable AEs in Dutch hospitals to gain insight in opportunities for cost savings. Trained nurses and physicians retrospectively reviewed 7,926 patient records in 21 hospita...
Article
Sex differences are found in most components of the insulin resistance syndrome and the associated cardiovascular risk profile. These differences are attributed to sex-specific sex steroid profiles, but the effects of sex steroids on the individual components of the insulin resistance syndrome remain incompletely understood. Prospective, interventi...
Article
To report the experience with treatment of hypogonadal men with the scrotal application of testosterone patches. Prospective and descriptive. In 12 unselected hypogonadal men (aged 27-58 years; serum concentration of testosterone < 10 nmol/l) who complained of adverse effects of oral androgen treatment, the treatment was changed to scrotal applicat...
Article
We prospectively studied the effects of cross-sex hormone administration on fat cell size and in vitro lipolytic activity in subcutaneous abdominal and gluteal fat biopsies obtained from 19 male-to-female (M-F) transsexuals and 17 female-to-male (F-M) transsexuals. The amount of subcutaneous fat at the abdominal and gluteal levels was quantified wi...
Article
Hormonal therapy and gender-confirming surgery are the treatments of choice in appropriately selected male-to-female transsexuals. Penectomy and vaginoplasty are the paramount surgical requests of the male transsexual, but breast enlargement greatly increases subjective feelings of femininity. There are only limited reports on augmentation mammapla...
Article
Large artery stiffening could contribute to the development of cardiovascular disease. The aim of this study was to investigate associations between arterial stiffness and diameter with insulin sensitivity and body composition in healthy men and women. In healthy, young (< 41 years old), non-obese (BMI < 27 kg/m2) men (n = 17) and women (n = 17), w...
Article
We investigated prospectively the effect of sex steroids on regional fat depots and thigh muscle mass in adult transsexuals. Ethinyl estradiol in combination with cyproterone acetate, a progestational antiandrogen, was given to 20 male-to-female (M-F) transsexuals, and parenteral testosterone esters were given to 17 female-to-male (F-M) transsexual...
Article
Increased plasminogen activator inhibitor type-1 (PAI-1) levels, leading to impaired fibrinolysis, are associated with increased visceral fat in middle-aged and obese subjects. It is unknown, however, whether this association is independent of other disturbances clustered in the insulin resistance syndrome. We analyzed this association in young, no...
Article
We studied thirteen male-to-female (M→F) and ten female-to-male (F→M) transsexuals who, for four months, received cross-sex treatment with, respectively, ethinylestradiol and cyproterone acetate, and with testosterone esters. We assessed the effects of treatment on plasma levels of tissue-type plasminogen activator (tPA), von Willebrand factor (vWF...
Article
It is unknown whether long term cross-sex hormone treatment affects the human skeleton. We monitored bone mineral density and biochemical markers of bone turnover for 28-63 months in 20 male-to-female transsexuals (M-->F) treated with anti-androgens and oestrogens, and 19 female-to-male transsexuals (F-->M) treated with androgens. They underwent go...
Article
It is unknown whether long term cross-sex hormone treatment affects the human skeleton. We monitored bone mineral density and biochemical markers of bone turnover for 28–63 months in 20 male-to-female transsexuals (M → F) treated with anti-androgens and oestrogens, and 19 female-to-male transsexuals (F → M) treated with androgens. They underwent go...
Article
Full-text available
Plasma total homocysteine (tHcy) levels are higher in men vs. premenopausal women, but it is not known whether this difference is related to sex steroids. The effects of cross-sex hormone administration on plasma tHcy levels were therefore investigated. Plasma tHcy levels were measured at baseline and after 4 months of treatment in 17 male-to-femal...
Article
Full-text available
To assess reproducibility, expressed as both inter-observer variability and intra-observer variability, of fat area measurements on images obtained by magnetic resonance (MR); to compare variability between fat area measurements, calculated from a single image per body region and from the average fat area of three images, and to determine reproduci...
Article
Women have higher circulating leptin levels than men. This sex difference is not simply explained by differences in the amount of body fat and is possibly influenced by their different sex steroid milieus. This prompted us to study prospectively the effects of cross-sex steroid hormones on serum leptin levels in 17 male to female transsexuals and 1...
Article
The optimum steroid hormone treatment regimes for transsexual subjects has not yet been established. We have investigated the mortality and morbidity figures in a large group of transsexual subjects receiving cross-sex hormone treatment. A retrospective, descriptive study in a university teaching hospital. Eight hundred and sixteen male-to-female (...
Article
The amount of intraabdominal (visceral) fat is an important determinant of disturbances in lipid and glucose metabolism. Cross-sectional studies in women have found associations between high androgen levels and visceral fat accumulation. The causal relation between these phenomena is unknown. We, therefore, studied prospectively the effect of testo...
Article
Histomorphometry was performed in iliac crest biopsies from 15 female-to-male (F-M) transsexuals with a mean age of 30 +/- 6.1 (SD) years. At the time of study, they had been treated with parenteral testosterone esters (250 mg/2 weeks) or oral testosterone undecanoate (160 mg/day), The median androgen treatment duration was 39 months, The patients...
Article
The effects of treatment with estrogens and antiandrogens in male to female (M-->F) transsexuals and androgens in female to male (F-->M) transsexuals on their respective bone metabolism, bone mineral density (BMD), serum insulin-like growth factor I (IGF-I) and IGF-binding protein-3 (IGFBP-3) levels were investigated. BMD and variables of bone turn...
Article
We report on unfavorable long-term results after rectosigmoid neocolpopoiesis in 12 patients, as well as on possible prevention and treatment of these results. To prevent neovaginal introitus stenosis, the rectosigmoid mucosa should be sutured to the perineal skin in an exaggerated interdigital fashion. In cases where introitus stenosis has develop...
Article
We studied prospectively the effect of exogenous testosterone (testosterone undecanoate [TU] 160 mg/d orally) on lipoprotein profiles in eight hypogonadal males and 10 females (female-to-male transsexuals). Testosterone administration to androgen-deficient men and to eugonadal women produced similar serum levels of testosterone (7.67 +/- 5.47 nmol/...
Article
Hyperinsulinemia is a common finding in hyperandrogenic women, during pregnancy, and in women using oral contraceptives. To test whether sex hormone treatment can induce insulin resistance in healthy subjects, we studied the effects of administration of testosterone to 13 female to male and of ethinyl estradiol to 18 male to female transsexuals. Ut...
Article
Hyperinsulinemia is a common finding in hyperandrogenic women, during pregnancy, and in women using oral contraceptives. To test whether sex hormone treatment can induce insulin resistance in healthy subjects, we studied the effects of administration of testosterone to 13 female to male and of ethinyl estradiol to 18 male to female transsexuals. Ut...
Article
A deficiency of sex hormones leads in both sexes to increased bone loss, and hormonal substitution can prevent this. The effect of the change of hormonal environment on bone metabolism in transsexuals is unknown. Transilial bone biopsies were obtained from 23 male-to-female transsexuals (mean age +/- SD, 38.0 +/- 11.7 years) after estrogen (ethinyl...
Article
Sex steroid treatment is associated with side effects. The number of deaths and morbidity cases in 425 transsexual patients treated with cross-gender hormones were evaluated retrospectively and compared with the expected number in a similar reference group of the population. The number of deaths in male-to-female transsexuals was five times the num...
Article
The effect of Anandron, a novel non-steroidal anti-androgen, on the reduction in sexual hair growth of 14 male-to-female transsexuals was investigated. Anandron (300 mg/day) alone for 8 weeks increased serum testosterone levels (mean: 19.2 +/- 6.1 to 44.9 +/- 11.5 mmol/l) and serum oestradiol levels (mean: 0.08 +/- 0.02 to 0.24 +/- 0.06 nmol/l). Fr...
Article
PRL levels were evaluated during long-term treatment with cyproterone acetate 100 mg and ethinyloestradiol 100 micrograms/day orally or depot-oestrogens in 214 male-to-female transsexuals. PRL levels increased above normal in all subjects (normal less than 300 mU/l). In 46 (21.4%) subjects PRL levels rose to greater than 1000 mU/l. The incidence of...
Article
Prolactinomas can be induced in rats by large doses of estrogens. Whether prolactinomas can be induced in humans by estrogens, however, is not known. This report describes the development of a prolactinoma in a man with previously normal plasma PRL levels after the administration of pharmacological doses of estrogen. The patient, a 26-yr-old male t...
Article
Nineteen patients with primary hyperparathyroidism were treated with 25 micrograms 24,25-dihydroxyvitamin D3 or placebo daily for 3 months according to double-blind cross-over protocol. Serum immunoreactive PTH, total and ionized calcium, urinary calcium excretion, tubular reabsorption of phosphate/glomerular filtrate, and urinary hydroxyproline ex...

Citations

... 12 On the other hand, transgender women usually struggle to achieve a gender-congruent voice, as HRT with antiandrogens (estrogens) feminizes the body but has no effects on their voices. 13 This is the reason why voice modification is requested especially by trans women, whose voice characteristics are often male-like and thus strongly contrasting with their identity and presentation as women. 14,15 Failing to reach a gender congruent voice might determine important negative effects on these subjects. ...
... It was observed a decrease in GIP but not in GLP-1 (82). Besides, a study of 18 transgender women treated with EE showed decreased glucose utilisation after 4 months of CHT (83). ...
... Aromatization of androgens should, in theory, protect transgender men from compromised bone mineral density (BMD) despite suppressed estradiol levels [58]. In patients who retain their gonads, there is no evidence that long-term testosterone therapy negatively impacts BMD [9,42,59]. ...
... A medication error (ME) is an error in the medication treatment process which may occur during all stages of medication use from ordering, through dispensing and administration, to monitoring. 1 MEs constitute a major challenge to patient safety 2 and are associated with patient harm and increasing national expenses. [3][4][5] The prevalence of preventable medication harm has been estimated to be 3% in adult patients in primary and secondary healthcare settings on average, with higher rates in elderly (11%) and intensive care patients (7%). 6 For example, in the UK, error-related harm is estimated to contribute to more than 1700 deaths per year, costing £98.5 million (€114.6 million) for hospital admissions and extended hospital stay. ...
... Missing from the literature are descriptions of effective clinical strategies based on transgender, and specifically nonbinary, individuals' common presenting concerns. Scholarly literature addressing the specific concerns of transgender clients is slowly increasing (Baral et al., 2013;Garcia, Christopher, De Luca, Spilotros, & Ralph, 2014;Gooren & Asscheman, 2014), but only recently have sex therapy interventions been discussed to address topics beyond a diagnosis of gender dysphoria, STI prevention, or medical transition-related concerns . Pleasure-oriented positive sexuality, as a core component of GALA, calls for a paradigm shift and centers the rights of all individuals across the gender spectrum to sexual empowerment and pleasure. ...
... For example, between 2014 and 2016, 60 cases of wrong-site surgery were reported to the DHI. 3 After the introduction of an incident reporting system as part of an obligatory safety management system in all hospitals in the Netherlands, the potentially avoidable mortality-which is measured every 4 yearsdecreased from 5.5% in 2008 to 2.6% in 2011/2012. 4 However, in 2017 it became clear that the potentially avoidable mortality did not further decrease. This was one of the main reasons for the Netherlands Institute for Health Services Research to advise the development of a joint approach to improve learning from SEs. 5 To accomplish this, transparency regarding dealing with SEs between healthcare organisations is needed. ...
... Older inpatients (aged ≥65 years) and, in particular, oldest-old inpatients (aged ≥80 years) are especially at risk of ADEs and pADEs. Over 30% of these patients experience at least one ADE during their hospital stay, and up to 70% of these events are deemed preventable [8,[16][17][18]. In addition, ADEs have more severe consequences in this population, such as inducing or worsening frailty; causing functional and cognitive disability; and leading to loss of autonomy, more frequent and prolonged hospitalizations, nursing home admissions, and even death [16,17,19]. ...
... 8 GM people who do not have health insurance are more likely to obtain hormones from sources other than licensed health care providers, increasing risk for harm. 9 For example, hormone misuse has been associated with increased risk of venous thromboembolism 10 and elevated liver enzymes. 11 Furthermore, injectable hormone use outside of medical supervision has been associated with increased risk of contracting HIV. 12 Lack of health insurance can also affect one's overall health. ...
... The latter study was repeated in 2008 and 2012. Although there was an improvement, still a considerable number of (potentially preventable) adverse events (AEs) was found [3,4]. Also a report by Landrigan et al. (2010) stated that further efforts are necessary to improve safety strategies and to monitor health care safety over time [5]. ...