InfertilityEffects of Estrogen on Spermatogenesis in Transgender Women
Section snippets
MATERIALS AND METHODS
This is an IRB-approved retrospective cross-sectional study. Subjects included all transgender patients undergoing gender-affirming orchiectomy, either alone or as a part of vaginoplasty at Oregon Health and Science University from May 2015 to January 2017. All subjects (n = 72) were taking cross-sex hormones for at least 1 year prior to orchiectomy. Subjects undergoing orchiectomy alone (n = 50) did not stop estrogen prior to surgery but those who had orchiectomy with vaginoplasty (n = 22)
RESULTS
There were 141 pathologic specimens from 72 patients for histologic analysis (Table 1). Median age was 39 [IQR 30-53], most patients were white (88%), median BMI was 26.6 [IQR 23.2-31.4], the median duration of hormone use was just over 3 years (39 months [IQR 24-65]). The median weight and volume of the gonads were 26.4 grams [IQR 23.3-33.0] and 14.2 mL [IQR 10.2-20.2], respectively. Germ cells were present in 114 (80%) of the specimens. Spermatids were identified in 57 (40%) of the gonads.
The
DISCUSSION
Our study finds that despite long-term cross-sex hormone therapy, germ cells persist in the vast majority of transgender women and over one third of these women have preserved spermatogenesis. This is in contrast to early research suggesting that estrogenization invariably leads to testicular atrophy and sterility, but is consistent with more recent studies showing that some patients do maintain spermatogenesis. In 1992, Lubbert et al investigated the effects of estrogen on hormonal and semen
CONCLUSION
Despite being on long-term hormone therapy, the majority (80%) of transgender women have persistent germ cells in their testicles, and over one third have preserved spermatogenesis. Larger testicular size reliably predicts preservation of spermatogenesis, and this may be used for preoperative fertility counseling. While these findings should lend optimism to the pursuit of fertility preservation in transgender women, future study is needed to characterize factors predictive of preserved
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Cited by (34)
Gender-affirming hormonal therapy for transgender and gender-diverse people—A narrative review
2023, Best Practice and Research: Clinical Obstetrics and GynaecologyCitation Excerpt :Even in transfeminine people who did not start GAHT yet, sperm quality is often lower compared with the World Health Organization (WHO) data for the general population [44], which could be attributed to wearing tight undergarments and a tucking (hiding the penis by pulling it back between the legs) frequency of more than eight times per month. Normal spermatogenesis has been reported in 0–48% of all orchiectomy specimens [45–50]. For example, in people using GAHT with spironolactone, testosterone levels are not completely suppressed.
The return of spermatogenesis in transgender women ceasing gender-affirming hormone therapy
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2023, Cell Reports MedicineFertility preservation and access to medically assisted reproduction for Trans people: Guidelines from French Professional Association for Transgender Health
2022, Gynecologie Obstetrique Fertilite et SenologieClinicopathologic features and proposed grossing protocol of orchiectomy specimens performed for gender affirmation surgery
2022, Human PathologyCitation Excerpt :Bilateral orchiectomy is often performed at an early stage of their transition as it reduces the production of endogenous androgens, allows for the discontinuation of anti-androgen therapy, and reduces the dosage of estrogen [3]. Previous studies have focused on the histologic changes related to hormone therapy, particularly estrogen, on spermatogenesis in the testis [4–11]. Therefore, we aimed to provide a clinicopathologic overview of the features identified within gender-affirming orchiectomies performed at our institution to summarize our experience, confirm previous findings, and devise a proposed grossing protocol to adequately assess these increasingly encountered specimens.
Funding: None.
Conflicts of interest: None.