Addition Of Cyproterone Acetate Research Articles

A systematic review of antiandrogens and feminization in transgender women.

Antiandrogens are frequently used with estradiol in transgender women seeking feminization. Antiandrogens act by various mechanisms to decrease the production or effects of testosterone, but it is unclear which antiandrogen is most effective at feminization. A systematic review was performed using PRISMA guidelines. We searched online databases (Medline, Embase and PsycINFO) and references of relevant articles for studies of antiandrogens in transgender women aged 16+ years to achieve feminization (namely changes in breast size, body composition, facial or body hair) or changes in serum total testosterone concentration when compared to placebo, estradiol alone or an alternative antiandrogen. Four studies fulfilled eligibility criteria and were included in a narrative review. The addition of cyproterone acetate, leuprolide and medroxyprogesterone acetate may be more effective than spironolactone or estradiol alone at suppressing the serum total testosterone concentration. Body composition changes appear similar in transgender women treated with estradiol and additional cyproterone acetate or leuprolide. No eligible studies adequately evaluated the effects of antiandrogens on breast development or facial and body hair reduction. It remains unclear which antiandrogen is most effective at achieving feminization. Cyproterone acetate, medroxyprogesterone acetate and leuprolide may be more effective than spironolactone at suppressing the serum total testosterone concentration. However, due to spironolactone's antagonism of the androgen receptor, it is unclear whether this results in clinically meaningful differences in feminization. Further research with clinically meaningful endpoints is needed to optimize the use of antiandrogens in transgender women.

Testosterone and corticosterone co-regulate messenger RNA coding for secretory proteins in the epididymis of the lizard (Lacerta vivipara)

The hormonal requirements for the regulation of Lv132 mRNA coding for two proteins secreted by the principal cells of the lizard epididymis were examined by organotypic culture experiments. Testosterone, R1881 and corticosterone induced accumulation of Lv132 mRNA in explants from lizards castrated immediately after differentiation of the principal cells. The induction by testosterone was inhibited by the addition of cyproterone acetate. Progesterone and oestradiol alone or in presence of testosterone were ineffective. Unlike the induction by testosterone, the effect of corticosterone did not require binding on the androgen receptor as shown by competition binding studies. Corticosterone failed to induce gene expression in organs containing only reserve cells in their epithelium at the onset of the culture. However, corticosterone plus testosterone had a synergistic effect. These data suggest that testosterone promotes the differentiation of principal cells from reserve cells during the culture time and that a primary action of testosterone is necessary to confer corticosterone responsiveness on this tissue. Furthermore, the primary effects of testosterone could be memorized by the tissue because the corticosterone responsiveness persists after castration.

Plasma ACTH in diagnosis and control of adrenal disorders.

Unstimulated plasma ACTH concentrations remain at or below the detection limit of conventional immunoassays. Grossly elevated ACTH concentrations are diagnostic in suspected adrenal insufficiency, remain elevated well above 200 ng/l during substitution therapy and obviate the need of further tests. For the diagnosis of secondary adrenal failure, plasma ACTH, cortisol and 11-desoxycortisol response to a single midnight dose of metyrapone (1.2 g/m2 = 30 mg/kg) discriminates between a normal (morning ACTH above 100 ng/l), diminished (morning ACTH detectable, but below 100 ng/l), and an absent (ACTH below 20 - 40 ng/l) ACTH reserve. In congenital adrenal hyperplasia, plasma ACTH concentrations mirror, together with 17-alpha-hydroxyprogesterone, the extent of ACTH suppression. Elevated ACTH concentrations were suppressed by prednisolone (25%), dexamethasone (2% of the hydrocortisone dose) or by addition of cyproterone acetate (100 mg/m2/day). Using selective venous catheterisation in clinically and biochemically proven Cushing's syndromes, a pituitary adenoma could be identified and localized in 6 of 8 patients by measuring ACTH concentrations in the left and right petrosal sinus before and after stimulation with corticotrophin releasing hormone.

Endocrine findings during hormonal treatment of metastasizing prostatic carcinoma

Endocrine findings of hypophyseal, testicular and adrenal function in the hormonal treatment of advanced prostatic carcinoma are described. Diethylstilbestrol (DES) reduces significantly the plasma levels of testosterone, follicle-stimulating hormone (FSH) and luteinizing hormone (LH). In contrast, those of prolactin, dehydoepiandrosterone (DHEA), and cortisol as well as sexual hormone binding globulin (SHBG) are elevated. The additional administration of bromocriptine decreases prolactin to normal levels and further decreases the testosterone levels. The adrenal steroids are influenced differently: DHEA decreases as compared to the DES-treated group, while the cortisol levels rise significantly. The addition of cyproterone acetate to the therapeutic regimen decreases the cortisol levels, and all other values, including SHBG, are not altered significantly compared to the group treated with DES plus bromocriptine. What is of interest is that the estradiol levels are not altered by any treatment schedule. In a group of patients, orchiectomized prior to our study, the endocrine values are compared to those mentioned above. Following orchiectomy FSH and LH levels rise significantly, but not prolactin and SHBG. The testosterone levels were as low as under treatment with DES. From our results it is concluded that the combination of DES plus bromocriptine plus cyproterone acetate best achieves the inhibition of androgenic influence onto the prostatic carcinoma.

The maturation of rabbit epididymal spermatozoa in organ culture: inhibition by antiandrogens and inhibitors of ribonucleic acid and protein synthesis.

Infertile spermatozoa from the proximal corpus epididymidis will become fertile when this epididymal segment is cultured 24 h in vitro with 5alpha-dihydrotestosterone (5alpha-DHT). The effect of antiandrogens and inhibitors of RNA and protein synthesis upon this 5alpha-DHT-induced sperm maturation was investigated. The response to 5alpha-DHT was abolished by cyproterone acetate, SKF 7690, actinomycin D, cycloheximide, puromycin, and the aminonucleoside analog of puromycin. Addition of cyproterone acetate or actinomycin D to a suspension of distal corpus spermatozoa did not change their fertilizing ability. Culture of segments of the distal corpus for 24 h with the same antiandrogens and RNA and protein synthesis inhibitors did not change the fertilizing ability of spermatozoa. These results indicate that the development of the sperm-fertilizing ability observed in the proximal corpus epididymidis in vitro in response to 5alpha-DHT is dependent upon binding of 5alpha-DHT and synthesis of new RNA and protein molecules by the target cell. They also indicate that antiandrogen and inhibitors of RNA and protein synthesis do not have a nonspecific toxic effect on spermatozoa during the time period studied. It is likely that the target cells are the epididymal epithelial cells rather than the spermatozoa themselves.