Estrogens Administration in Female Transsexuals Augmented Delta andRem Sleep Stages after Six Months of Treatment

Abstract

The transsexual condition (TS) (Gender Dysphoria DSM-5) people have a marked incongruence between the gender they have been assigned at birth and their experienced/expressed gender. There are variations in brain structures that express reproductive behavior mainly in the hypothalamus. Also, there are sleep differences between non-transsexual female and male. This gender dimorphism in the sleep regulation is due to anatomical changes previously reported in the hypothalamus, which would suggest that it could also find significant differences in sleep architecture in transsexual persons, before and after hormonal treatment with estrogens. Six persons diagnosed with gender identity disorder according to DSM IV-TR, were studied. Also 16 healthy volunteers men (n=6) and women (n=10) were included. A polysomnography base study in which a baseline night recording as well as at 3 and 6 months was performed, with a portable polysomnographic system, for MTF transsexuals. Healthy volunteers were studied only one baseline night. Hormone therapy was administered as conjugated estrogens 0.625 mg/d. (PremarinPfizer), within six months of the present protocol, there were measurements of hormone levels at baseline, three to six months. A descriptive analysis of sexual hormones in plasma, before hormone treatment and sleep variables were performed. They were within normal distribution. The Kolmogorov Smirnov test to asses normality within sleep variables showed normal distribution, so that parametric tests for comparison of those variables could be made. The main significant differences between male and female controls were that the second group had short sleep latency and higher REM sleep time and REM sleep percentage. Sleep variables between female controls and MTF after six months of estrogens had differences in sleep stages 2, 3 and REM. Then a correlation analysis between the hormone levels at different time of their administration and percentages for each of the sleep variables at baseline, 3 and 6 months were performed and it was found that the proportion of N2 is linked to changes in the levels of luteinizing hormone having a Person correlation coefficient of 0.484. Finally, an ANOVA and post hoc analysis was performed to see the difference between sleep variables in transsexual subjects at baseline and at 6 months vs. non-transsexual women and men. Conclusions: The main findings of the present study were that after six months of treatment with estrogens in MTF transsexuals there was an increase in sleep stages 2, 3 and REM, comparing with female controls, and that correlates with luteinizing hormone.