Anthea P.W. Makepeace,
3rd September 2014
This file is endotrpr.html

email: antheamakepeace@yahoo.co.uk 
        anthea@antheamakepeace.co.uk

        http:www.antheamakepeace.co.uk 

A Comparison of Endocrine Treatment for MtoF Transsexuals and Prostate Cancer

The Endocrine treatment for Male to female transsexuals has much in common with the Androgen Deprivation Therapy (ADT) used for some forms and stages of Prostate Cancer.

Cross fertilisation between the two disciplines may lead to a better understanding for example of Osteoporosis (Preston et al, 2002) 

We need to improve the treatment procedures especially for those being treated simultaneously for both conditions.

Male to Female Transsexuals.

Initial treatment is to achieve Testosterone and Oestradiol serum levels appropriate to a natal female.

Subsequently Genital Reassignment Surgery (GRS) may be performed (not in all cases) which will include orchiectomy, and possibly, penotomy, and vaginoplasty.
Orchiectomy maybe performed on its own but where vaginoplasty is proposed Scrotal tissue will be required as part of the reconstructive procedure.

Post Orchiectomy The dose of Anti androgens will require re-evaluation in a downwards. Direction.

In some cases the anti androgen effect of Oestradiol on its own is sufficient to control Androgen (Testosterone) levels in Transsexuals.

Initially (1940s) oestradiol was the only available anti androgen and coupled with orchiectomy was the treatment available.

Castration (sic) or Orchiectomy was still the  procedure of choice until the availability of  non steroidal anti-androgens 



References
  1. All these references can be downloaded from the internet in their entirety.
  2. The important references listed only in the individual bibliographies are not available for free.
  3. Some papers are not peer reviewed and are personal views and highly provocative.   Look at the original publication, if any!
  4. Charles Huggins Nobel Lecture of 1966 elegant description of early work.  It should not be overlooked.
  5. The Wikepedia articles are easy to read and provide a useful start.
  6. Unfortunately the important references are not available without an academic library or academic access.
Therapy Insight:parenteral estrogen treatment treatment for prostrate cancer – a new dawn for an old therapy 
Ockrim J., et  al, 
Nature Clinical practice oncology Oct. 2006 Vol 3 No.10 p652
http://www.nature.com/nrclinonc/journal/v3/n10/pdf/ncponc0602.pdf 

Androgen deprivation in men with prostrate cancer is associated with an increased 4rate of bone loss
Preston D et al
Prostate Cancer and Prostatic Diseases (2002) 5, 304 -310
http://www.nature.com/pcan/journal/v5/n4/pdf/4500599a.pdf 

Oestradiol dosage for different conditions
http://www.drugs.com/dosage/estradiol.htm 

NICE – Prostate Cancer Clinical Guide  175
Page24 deacovers treatmment for Hot Flushes  - side effect of hormone therapy
http://www.nice.org.uk/guidance/cg175/resources/guidance-prostate-cancer-diagnosis-and-treatment-pdf

An Interesting website – no peer review and very few references
http://www.hemingways.org/GIDinfo
and specifically 
http://www.hemingways.org/GIDinfo/hrt_m2f.htm 

part of book all downloadable 
Menopause and Andropause :Hormone replacement Therapy through the ages -New cognition and concepts ISBN 978-3-901299-39-36
http://www.kup.at/cd-buch/8-inhalt.html 



Hormone Heresy – Oestrogen's Deadly Truth   Sherrill Sellman (1996)
Nexus Magazine
http://www.whale.to/m/sellman1.html  

Transdermal estradiol (TDE) androgen deprivation therapy  MaacK C.  Pr9ostate Cancer activist.   
Http://www.ustoowichita.org  -is a national US Prostate cancer support group
http://www.ustoowichita.org/pdf/TRANSDERMAL%20ESTRADIOL.pdf 

Estradiol suppresses tissue androgens and prostate cancer growth in castration resistant prostate cancer.   Montgomery B. et al (2010)
Biomedcentral is a publisher of peer reviewed open access journals
http://www.biomedcentral.com/1471-2407/10/244 

Estrogen action and prostate cancer
Nelles J. et al (2010)
http://www.ncbi.nih.gov/pmc/articles/pmc3134227/pdf/nihms3019452.pdf 

Prostatecancer. Net  is the website of the Prostate Cancer Institute – provenance unknown -seems to be heavily loaded with advertisements)
http://www.prostate.net/prostate-health/testosterone-hormones-and-prostate-health 
http://www.prostate.net/wp-content/uploads/pdf/questions-to-ask-your-doctor-about-hormone-therapy.pdf 

Useful Wikipedia articles:-
http://www.en.wikipedia.org/wiki/prostate_cancer 

The Tumour rating score
http://www.en.wikipedia.org/wiki/Gleason_score

http://www.en.wikipedia.org/wiki/antiandrogen

http://www.en.wikipedia.org/wiki/discovery_and_development_of_antiandrogens

http://www.en.wikipedia.org/wiki/Androgen_deprivation_therapy 

http://www.en.wikipedia.org/wiki/estradiol

PREMARIN = PREgnant Mare uRINe  - first commercial Oestragen medication (1942)
http://www.en.wikipedia.org/wiki/premarin

First used oestrogen to treat Prostate Cancer 
http://www.en.wikipedia.org/wiki/Charles_Brenton_Huggins
1966 Nobel Prize for Medicine or Physiology was shared by Brenton & Rous
Huggins – Endocrine Regression of Cancers  -Classic paper well worth reading today
http://www.nobelprize.org/nobel_prizes/medicine/laureates/1966/huggins-lecture.pdf

Rous – The challenge to man of the Neoplastic Cell
http://www.nobelprize.org/nobel_prizes/medicine/laureates/1966/rous-lecture.html   

Hormone Therapy for Prostate Cancer: What have we done with Charles Huggins' legacy? Bertrand Tombal, European Urology 61 issuee 1 Jan. 2012  26-28

http://www.europeanurology.com/article/S0302-2838%2811%2901012-8/pdf/hormone-therapy-for-prostate-cancer-what-have-we-done-with-charles-huggins-x02019-legacy `

ADT related papers anthea@antheamakepeace.co,uk


http://www.cancernetwork.com/articles/osteoporosis-seen-patients-long-term-androgen-deprivation


ADT in the treatment of advanced prostate cancer Perimutter M A, Lepor H

Rev Urol 2007, 9(Suppl 1) S3-S8 - Lots of refs all accessible

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1831539/


Quality of life following localised prostate Cancer treated initially with ADT or no Therapy

Potosky et al J National Cancer Institute (2002)94 (6) 430-437

http://jnci.oxfordjournals.org/content/94/6/430.full


Patient Information: Treatment for advanced prostate cancer (beyond the basics)

(including ADT & side effects

http://www.uptodate.com/contents/treatment-for-advanced-prostate-cancer-beyond-the-basics


ADT induced fractures in men with nonmetastatic Prostate Cancer: What do we really know?

http://www.medscape.org/viewarticle/567799_4


Prevalence of Osteoporosis & Osteopenia during ADT for prostate cancer

Malkowicz et al Journal of Clinical Oncology V 25 No. 165 (2007) 5116

http://meeting.ascopubs.org/cgi/content/short/25/18_suppl/5116


Popular!

http://www.news-medical.net/health/Estradiol-Side-Effects.aspx


http://www.drugs.com/sfx/estradiol-side-effects.html


Oestrogen replacement Therapy & Mood (popular)

http://www.macalester.edu/academics/psychology/whathap/ubnrp/estrogen/ertmood.html


Increased estradiol and improved sleep, but not hot flushes, predict mood during the menopausal transition. Hall E & Cohen LS et al

J Clin. Endocrinology & metabolism V 96, 7 (2011)

http://press.endocrine.org/doi/abs/10.1210/jc.2010-2503


Useful Wiltshire NHS HRT guidance chart

http://www.gwh.nhs.uk/media/163808/wiltshire_hrt_guidance_2014.pdf


Potential side effects of ADT in sex offenders, Giltay et al

J Am Acad of Psychiatry and the law 37, no.1 53-58 (2009)

http://www.jaapl.org/content/37/1/53.full


Relationship between ADT and male meningioma, Li et al

Prostatic Cancer and Prostatic diseases 16, 387-390 (2013)

http://www.nature.com/pcan/journal/v16/n4/full/pcan201345a.html


http://prostatecanceruk.org/toolkits/living-with-hormone-therapy


Living with hormone therapy for men with Prostate cancer pp 72

http://prostatecanceruk.org/media/41582/1280_living_with_hormone_therapy.pdf