Spermatogenesis Abnormalities following Hormonal Therapy in Transwomen.

OBJECTIVE

To measure spermatogenesis abnormalities in transwomen at the time of sex reassignment surgery (SRS) and to analyze the association between hormonal therapy duration and infertility severity.

DESIGN

Retrospective study.

SETTING

University hospital.

PATIENTS

One-hundred seventy-three transwomen who underwent SRS from January 2000 to December 2015.

INTERVENTIONS

All orchidectomy specimens were retrospectively reviewed and classified. History of hormonal therapy duration was retrieved from medical records.

MAIN OUTCOME MEASURES

Histological examinations of orchidectomy specimens were performed to assess spermatogenesis.

RESULTS

One-hundred seventy-three orchidectomy specimens were evaluated. Histological examinations showed maturation arrest in 36.4%, hypospermatogenesis in 26%, Sertoli cell-only syndrome in 20.2%, normal spermatogenesis in 11%, and seminiferous tubule hyalinization in 6.4% of the specimens. Spermatogenesis abnormality severity was not associated with the total therapy duration ( = 0.81) or patient age at the time of surgery ( = 0.88). Testicular volumes and sizes were associated with spermatogenesis abnormality severity ( = 0.001 and = 0.026, right testicle and left testicle, resp.).

CONCLUSIONS

Feminizing hormonal treatment leads to reductions in testicular germ cell levels. All transwomen should be warned about this consequence, and gamete preservation should be offered before starting hormonal treatment.