Elshimy Ghada, Tran Kelvin, Harman Sherman M, Correa Ricardo
Division of Endocrinology, Diabetes and Metabolism, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona.
Phoenix VA Medical Center (VAMC), Phoenix, Arizona.
J Endocr Soc. 2020 Jun 18;4(7):bvaa074. doi: 10.1210/jendso/bvaa074. eCollection 2020 Jul 1.
Management of gender-affirming hormone therapy (HT) in transgender women includes surveillance of testosterone (T) levels. Failure of T to suppress, despite adherence to therapy, warrants additional investigations for unexpected sources of T or factors stimulating T secretion. Possible causes include T or gonadotropin production by an occult neoplasm. Testicular cancer is the most common malignancy affecting biological men aged between 15 and 35 years. Patients may be asymptomatic until tumor burden is high and/or metastatic. Hormone-producing tumors have rarely been reported in treated transgender women. Routine screening tests are recommended in a gender-incongruent person as per the 2017 Endocrine Society guidelines with measurement of T levels every 3 months initially to reach a goal of less than 50 ng/dL. Expectations should be discussed in detail with the transgender person since anticipated physical changes may not be notable for 6 to 18 months. We herein describe a case of a transgender woman who underwent standard HT including gonadotropin suppression with a gonadotropin-releasing hormone agonist, whose total T level failed to suppress. Testing revealed an elevated serum level of the beta subunit of human chorionic gonadotropin (β-hCG), diagnostic of an hCG-secreting testicular seminoma, as the underlying cause of unexpected T production. This case illustrates how easily a testicular cancer can remain unnoticed because it can be asymptomatic and the necessity to be alert to, and act on, anomalous laboratory results during treatment of a transgender person.
对跨性别女性进行性别肯定激素治疗（HT）的管理包括监测睾酮（T）水平。尽管坚持治疗，但T未能被抑制，这就需要对T的意外来源或刺激T分泌的因素进行进一步调查。可能的原因包括隐匿性肿瘤产生T或促性腺激素。睾丸癌是影响15至35岁生物学男性的最常见恶性肿瘤。在肿瘤负荷高和/或发生转移之前，患者可能没有症状。在接受治疗的跨性别女性中，很少有激素分泌肿瘤的报道。根据2017年内分泌学会指南，建议对性别不一致的人进行常规筛查，最初每3个月测量一次T水平，以达到低于50 ng/dL的目标。由于预期的身体变化在6至18个月内可能不明显，因此应与跨性别者详细讨论预期情况。我们在此描述了一例跨性别女性病例，该患者接受了包括用促性腺激素释放激素激动剂抑制促性腺激素在内的标准HT治疗，但其总T水平未能被抑制。检测发现血清人绒毛膜促性腺激素β亚基（β-hCG）水平升高，诊断为分泌hCG的睾丸精原细胞瘤，这是意外产生T的根本原因。该病例说明了睾丸癌如何因无症状而容易被忽视，以及在跨性别者治疗期间对异常实验室结果保持警惕并采取行动的必要性。
