Transgender/PCOS

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Barbara Nesbitt:  “Hi, this is Barbara Nesbitt, and I am at the PCOS Conference in San Diego.  I would like Paula Puffer, who is the web-mistress of the PCOS Support website and also the Coordinator of OBGYN.net PCOS Pavilion, to say hello, and she’s going to do an interview.”

Paula Puffer:  “Hello, this is kind of a spur of the moment thing so I really don’t have any set questions but I’m sitting here with Walter Futterweit who is with the Mount Sinai School of Medicine in New York City.  In some of my work as PCO Support web-master, I’ve had the privilege of putting up Dr. Futterweit’s articles on our bibliography of professional journal articles, and one of the things that I found quite interesting is that he has done research with women who want to become men and PCOS and how the changes with the hormones and stuff have affected them and affected their ovaries.”

Dr. Walter Futterweit:  “This is quite a diversion to talk about this subject at this momentous meeting here in San Diego.  I must say that a lot of this work is still ongoing, and as a member of the Harry Benjamin Foundation, which is a group of specialists interested in gender patients and the treatment prior to and post-sex reversal surgery, I’ve had occasion to study at least eighty women who were desirous of becoming men.  During that time, we found that 27% had features of polycystic ovary prior to treatment with male hormone and after the treatment with testosterone, 75%-80% had enlarged polycystic ovaries which were exactly identical to those found in women with polycystic ovary syndrome.  So this is quite a significant percentage and makes us think again of other potential pathological or physiological derangements that may occur not just in terms of altering the mindset of genetic females but what it is that also may be a factor in the causation of PCOS.”

Paula Puffer:  “What kind of changes beyond the physiological changes that many of us already know have you seen in transgendered women?”

Dr. Walter Futterweit:  “A number of them have significant facial hair, they have the enhanced sensitivity of the hair follicle to a normal or slight increased levels of male hormone, and in some there were irregular periods.  So as mentioned, a fair number of them already had polycystic ovary syndrome, that doesn’t mean to say that women with PCOS have a higher tendency to have gender disorders.  It just means that in the series of patients that were selected that I have seen, a certain number of them did have PCOS.  This in itself is quite exciting because the fact of the matter is that male hormones not only affected the physical development, the mental development, the psych for the psych of the patient but caused presumedly in the rest of the patients features of polycystic ovaries demonstrating for the first time in vivo, in the human that testosterone causes the anatomical changes of polycystic ovary syndrome.”

Paula Puffer:  “You mentioned a little bit about mental changes, what kind of changes are those?”

Dr. Walter Futterweit:  “An assertiveness, an aggressiveness, not just the male habitus, increased perspiration, thinning hair, change in voice, a swaggering gait, and a more masculine aggressiveness which are associated with features of increased male hormones, and of course increased sexual desire.”

Paula Puffer:  “I do a lot of online work with PCOS Support and one of the lists I’m on is directed directly at lesbian and bisexual women.  We’ve often talked on that list about how we think differently as far as having PCOS just because we don’t know if it’s the extra testosterone, I hear it so many times that women can multi-task but we also have the analytical capabilities or the more scientific based capabilities.  Now whether this is true or not or whether there’s any cognitive way of assessing that has yet to be seen but just as a group, I think women with PCOS, and maybe you’re better qualified to think about this because of the many women you see, but we tend to be a group of over achievers.  Would you say that is true?”

Dr. Walter Futterweit:  “I think you’re right.  I modestly feel that with my experience of close to 1,200 women with PCOS over the last twenty-five years or so most of the women tend to be bright, extremely intelligent, and very motivated.  They come from various walks of life but one thing they have in common is a uniformed desire to improve their lot, to enhance their ability to change to something that they would like to see, improved appearance, or the possibility if they wish to achieve fertility and to assume a normal life.  In terms of gender changes, I have not been struck by any major difference, that doesn’t mean that a statistical study may not show that.  It is something that I think should be looked into, however, more carefully.”