Antimullerian hormone levels decrease in female-to-male transsexuals using testosterone as cross-sex therapy

Objective: To investigate the effect of hormonal androgenic treatment on antimullerian hormone (AMH) serum levels in female-to-male (FtM) transsexuals. Polycystic ovary syndrome (PCOS) is associated with elevated AMH levels. Some hypothesize that the high AMH level is a consequence of androgen-induced excessive development of small antral follicles. However, this role of androgens is not yet clear. Design: Observational, prospective, cohort study. Setting: Tertiary academic medical center. Patient(s): Twenty-two FtM transsexuals, healthy native females receiving cross-sex hormone therapy/androgenic treatment. Intervention(s): Androgenic treatment with testosterone (T) and an aromatase inhibitor while endogenous hormone secretion was suppressed with the use of a GnRH agonist. Main Outcome Measure(s): Hormone concentrations were measured before and after androgenic treatment (administration of T and aromatase inhibitor). Measured hormones: AMH, inhibin B, T, androstenedione, DHEAS, E-2, SHBG, LH, and FSH. Result(s): AMH concentrations were significantly lower after androgenic treatment (4.4 +/- 4.4 mg/L vs. 1.4 +/- 2.1 mg/L). Androgenic treatment resulted in a strong suppression of AMH secretion over a relative short period of 16 weeks. Conclusion(s): Our data underscore the likely important role of androgens in the dynamics of folliculogenesis. It challenges the idea that androgens induce high AMH levels, which is gaining more interest nowadays as an important particular PCOS feature. This strong decline furthermore indicates that AMH must be interpreted in the context of other reproductive endocrine conditions. Clinical Trial Registration Number: NTR2493. (C) 2015 by American Society for Reproductive Medicine.