Gooren L J, Giltay E J
Emeritus VU University Medical Center, Amsterdam, The Netherlands.
Andrologia. 2014 Jun;46(5):570-5. doi: 10.1111/and.12111. Epub 2013 May 19.
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 in males. A large number of metabolic variables are influenced by sex hormones and consequently show difference between men and women, and this helps to explain differences in pathologies, such as cardiovascular disease, bone fractures and auto immune disease. There is some recent evidence that some sex differences in brain functions are not mediated by sex hormones, but by-products of genes located on the X and Y chromosomes. This communication reviews the results of administration of cross-sex hormone treatment to transsexual persons transitioning to the other sex. Natal males are treated with anti-androgens+oestrogens and natal females with testosterone. This provides a unique opportunity to study which metabolic functions are not irreversibly sex-differentiated but are determined by the prevailing milieu of sex steroids. The insights gained with these studies should lead to a better appreciation of the role of sex steroids in cardiovascular disease and diabetes mellitus which presently do not receive due attention.
哺乳动物的性别分化很大程度上是由雄性体内雄激素的存在以及雌性体内雄激素的缺失所驱动的。雄激素的存在会在雄性体内引发一些不可逆的变化：在出生前，会导致生殖器分化；在青春期，会促使第二性征发育——男性面部骨骼、手、脚更大，身高更高。大量代谢变量受到性激素影响，因此男性和女性之间存在差异，这有助于解释诸如心血管疾病、骨折和自身免疫性疾病等病症上的差异。最近有证据表明，大脑功能中的一些性别差异并非由性激素介导，而是由位于X和Y染色体上的基因的副产物介导。本通讯综述了对变性者进行跨性别激素治疗以转变为另一性别的给药结果。出生时为男性的人接受抗雄激素+雌激素治疗，出生时为女性的人接受睾酮治疗。这提供了一个独特的机会来研究哪些代谢功能并非不可逆转地进行性别分化，而是由当时占主导的性类固醇环境所决定。通过这些研究获得的见解应该会使人们更好地认识到性类固醇在心血管疾病和糖尿病中的作用，而目前这些作用并未得到应有的关注。
