摘要目的:探讨醋酸环丙孕酮(CPA)与螺内酯(SPL)在易性症(男转女)中抗雄激素效果的差异。方法:2012年1月至2021年9月，在北京大学第三医院就诊且连续规律用药≥3个月的易性症(男转女)185例(CPA组95例，SPL组90例)，年龄16~40(23±5)岁，收集末次就诊的资料和实验室指标进行横断面研究。结果:CPA组中位剂量25 mg/d，SPL组中位剂量80 mg/d，两组口服戊酸雌二醇中位剂量均为2 mg/d。与SPL组相比，CPA组总睾酮水平更低[0.7(0.7~1.5) nmol/L和13.2(6.7~18.4) nmol/L, U＝6 970.50， P<0.001]，在自我报告外生殖器萎缩、勃起减少、体毛减少、皮肤改善及体态女性化方面有较好的主观效果(均 P<0.05)。CPA组泌乳素水平高于SPL组[21.5(12.6~30.1) ng/ml和11.9(7.7~20.0) ng/ml， U＝2 053.50， P<0.001]。 结论:CPA比SPL降低血清睾酮作用更显著，在外生殖器萎缩、勃起减少、体毛减少、皮肤改善及体态女性化方面自我体验效果优于SPL，但发生高泌乳素血症风险更高。

abstractsObjective:To compare the anti-androgenic effect of cyproterone acetate (CPA) and spironolactone (SPL) on male-to-female transsexuals.Methods:From January 2012 to September 2021, 185 male-to-female transsexuals (95 using CPA and 90 using SPL) who visited the Peking University Third Hospital and under stable medication for ≥3 months were enrolled, aged 16 to 40 (23±5) years. General information and laboratory indicators of the last visit were collected for a cross-sectional study.Results:The median doses of antiandrogens in the CPA group and SPL group were 25 mg/d and 80 mg/d, respectively. And the median dose of oral estradiol valerate in both groups was 2 mg/d. Testosterone level in the CPA group was significantly lower than the SPL group [0.7 (0.7-1.5) nmol/L vs. 13.2(6.7-18.4) nmol/L, U= 6 970.500, P<0.001]. The CPA group also had better subjective effects on testicular atrophy, erection decrease, body hair decrease, skin softening and figure feminization (all P<0.05). The prolactin level of CPA group was significantly higher than that of SPL group [21.5 (12.6-30.1) ng/ml vs. 11.9 (7.7-20.0) ng/ml, U= 2 053.500, P<0.001]. Conclusions:CPA has a more significant effect on lowering testosterone levels than SPL, and is better than SPL in terms of testicular atrophy, erection decrease, body hair decrease, skin softening and figure feminization, albeit with a potentially higher risk of hyperprolactinemia.