Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, MA, USA.
Department of Pediatric and Adolescent Gynecology, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA.
J Sex Med. 2020 Sep;17(9):1807-1818. doi: 10.1016/j.jsxm.2020.05.029. Epub 2020 Jul 20.
As transmasculine persons utilize androgen gender affirming hormone therapy as a part of transition, guidance has been lacking on the effects of the therapy on the ovaries, especially for those who may desire retention.
To describe the ovarian histopathology of transmasculine persons on testosterone therapy following oophorectomy at the time of hysterectomy performed for gender affirmation.
This was a multicenter case series study of transmasculine patients on testosterone therapy who underwent hysterectomy with oophorectomy for gender affirmation between January 2015 and December 2017 at 5 tertiary care referral centers. Patients were identified by their current procedural and International Classification of Diseases codes.
Pre-, perioperative, and pathologic data were obtained from the electronic medical records and ovarian tissue descriptions from pathology reports were grouped into the following classifications: (i) simple/follicular cysts; (ii) polycystic ovaries; (iii) complex cysts; (iv) endometriomas; (v) other masses; (vi) atrophy; and (vii) normal.
85 patients were included in the study. At the time of oophorectomy, the mean age and body mass index of the cohort were 30.4 ± 8.4 years and 30.2 ± 7.3 kg/m, respectively, and the average interval from the initiation of testosterone to oophorectomy was 36 0.3 ± 37.9 months. On examination of ovarian histopathology, 49.4% (42) of specimens were found to have follicular/simple cysts, 5.9% (5) were polycystic, and 38.8% (33) had normal pathology. For those specimens with volume documented (n = 41), the median volume was 9.6 (range 1.5-82.5) cm. There was no association between the duration of testosterone therapy or body mass index and the presence of cysts in the ovaries.
The results of this study reported benign histopathology in ovaries of a large cohort of transmasculine persons on testosterone which should be included when counseling patients on ovarian retention, as transmasculine patients may choose to retain their ovaries while on testosterone for a variety of reasons (including no desire to undergo surgery, desire for backup sex steroids, and potential use for future fertility).
STRENGTHS & LIMITATIONS: This is a large multicenter study seeking to address the uncertainty in present counseling surrounding ovarian conservation in transmasculine persons on testosterone therapy. Its limitations included its retrospective nature and inability to address ovarian function after testosterone discontinuance.
In this cohort of transmasculine patients on testosterone therapy undergoing hysterectomy with oophorectomy for gender affirmation, ovarian histopathology was benign in all the specimens. Grimstad FW, Fowler KG, New EP, et al. Ovarian Histopathology in Transmasculine Persons on Testosterone: A Multicenter Case Series. J Sex Med 2020;17:1807-1818.
作为跨性别男性，在接受作为过渡一部分的雄激素性别肯定激素治疗时，人们对该疗法对卵巢的影响缺乏指导，尤其是对于那些可能希望保留卵巢的人。
描述跨性别男性在接受睾丸激素治疗时的卵巢组织病理学，这些人在因性别肯定而进行的子宫切除术时同时进行了卵巢切除术。
这是一项多中心病例系列研究，纳入了 2015 年 1 月至 2017 年 12 月期间在 5 家三级转诊中心因性别肯定而行子宫切除术和卵巢切除术的接受睾丸激素治疗的跨性别男性患者。通过当前的操作程序和国际疾病分类代码识别患者。
85 例患者纳入研究。在卵巢切除时，队列的平均年龄和体重指数分别为 30.4 ± 8.4 岁和 30.2 ± 7.3 kg/m2，从开始睾丸激素治疗到卵巢切除的平均时间为 36 0.3 ± 37.9 个月。在卵巢组织病理学检查中，49.4%（42 例）的标本发现有卵泡/单纯性囊肿，5.9%（5 例）为多囊性，38.8%（33 例）为正常病理学。对于有记录体积的标本（n=41），中位数体积为 9.6（范围 1.5-82.5）cm。睾丸激素治疗持续时间或体重指数与卵巢内囊肿的存在均无关联。
这项研究报告了接受睾丸激素治疗的大量跨性别男性的卵巢良性组织病理学，这在为选择保留卵巢的患者提供咨询时应该考虑到，因为跨性别男性可能出于各种原因（包括不想接受手术、希望保留备用性激素以及未来生育的潜在可能性）在接受睾丸激素治疗期间选择保留卵巢。
本研究为回顾性研究，且无法解决睾丸激素停药后卵巢功能的问题。
