Oregon Health & Science University, Department of Urology, Transgender Health Program, Portland, OR.
Oregon Health & Science University, Department of Pathology, Portland, OR.
Urology. 2019 Oct;132:117-122. doi: 10.1016/j.urology.2019.06.034. Epub 2019 Jul 13.
To characterize spermatogenesis in the estrogenized transgender patient.
This is a retrospective, single-center, cross-sectional study. Seventy-two transgender women underwent gender-affirming orchiectomy between May 2015 and January 2017. All were on long-term (>1 year) cross-sex hormonal therapy prior to orchiectomy. Patient data were obtained via chart review. Histologic analysis was performed by a pathology resident under the supervision of a genitourinary pathologist. The main outcome is histologic presence of germ cells and presence of spermatids (a proxy for preserved spermatogenesis) in orchiectomy specimens.
There were 141 pathologic specimens available for analysis. Germ cells were present in 114 out of 141 (81%) testicles. Spermatids were present in 57 (40%) testicles. Presence of germ cells was associated with older age (43 vs 35 years, P = .007) and increased testicular weight (28.6 g vs 19.3 g, P <.001). Presence of spermatids was associated with increased weight (31.5 g vs 23.3 g, P <.001) and volume (20.3 mL vs 12.6 mL, P <.001). There was a linear correlation between testis volume and preserved spermatogenesis (Pearson's r = 0.448, P <.001).
Despite long-term hormone therapy, the majority (80%) of transgender women have germ cells present in the testicle. Spermatogenesis is preserved in approximately 40% of these individuals. Duration of hormonal therapy did not affect the degree of preservation of germ cells or spermatogenesis but starting hormonal treatment at a younger age may be associated with decreased germ cells in the testicle. Volume of testicles predict presence of preserved spermatogenesis.
描述经雌激素治疗的跨性别患者的精子发生情况。
这是一项回顾性、单中心、横断面研究。72 名跨性别女性于 2015 年 5 月至 2017 年 1 月期间接受了性别肯定性腺切除术。所有患者在性腺切除术前均接受了长期（>1 年）跨性别激素治疗。通过病历回顾获取患者数据。由一名病理住院医师在泌尿生殖病理学家的监督下进行组织学分析。主要结局是组织学上存在生殖细胞和精母细胞（保留精子发生的替代指标）。
共有 141 例病理标本可供分析。141 个睾丸中有 114 个（81%）存在生殖细胞。57 个（40%）睾丸中存在精母细胞。存在生殖细胞与年龄较大（43 岁 vs 35 岁，P=0.007）和睾丸重量增加（28.6 克 vs 19.3 克，P<0.001）相关。存在精母细胞与睾丸重量增加（31.5 克 vs 23.3 克，P<0.001）和体积增加（20.3 毫升 vs 12.6 毫升，P<0.001）相关。睾丸体积与保留的精子发生之间存在线性相关性（Pearson's r=0.448，P<0.001）。
尽管长期接受激素治疗，大多数（80%）跨性别女性的睾丸中仍存在生殖细胞。这些个体中约有 40%保留了精子发生。激素治疗的持续时间并不影响生殖细胞或精子发生的保留程度，但在较年轻时开始激素治疗可能与睾丸中生殖细胞减少有关。睾丸体积预测保留的精子发生的存在。
