Sinha Annika, Mei Lin, Ferrando Cecile
Department of Obstetrics and Gynecology, Cleveland Clinic Foundation, Cleveland, Ohio.
F S Rep. 2021 Jun 11;2(3):347-351. doi: 10.1016/j.xfre.2021.06.002. eCollection 2021 Sep.
To describe the histopathologic parameters of orchiectomy specimens obtained after gender-affirming surgery from transgender women who used gender-affirming hormone therapy (GAHT), which included estrogen and spironolactone. Our hypothesis was that an increasing duration of GAHT affects testicular health.
Retrospective cohort study.
Tertiary referral center.
All transgender women (individuals assigned male at birth who identified as female) who underwent orchiectomy with or without vaginoplasty between December 2015 and March 2020.
GAHT (estrogen and spironolactone) in the setting of patients with orchiectomy with or without vaginoplasty.
Demographic and perioperative data and pathology records were reviewed. The following pathology parameters were recorded: testicular volume, testicular weight, presence of spermatogenesis (active vs. reduced), maturation arrest, testicular atrophy, hyalinization, scarring/fibrosis, and Sertoli cell and Leydig cell phenotypes. The patients were grouped into one of three categories describing the duration of GAHT use: 0-36 months, 37-60 months, and >60 months years. Descriptive statistics were performed and comparisons between outcomes (demographic data and pathology parameters) were made among the GAHT groups.
Eighty-five (N = 85) patients underwent orchiectomy during the study period with 85.9% (n = 73) undergoing concurrent vaginoplasty. The mean (SD) age and body mass index of the cohort were 39 ±16 years and 28.4 ± 5.4 kg/m, respectively. In addition, although this was not statistically significant, patients in the 37-60 and >60-month groups were more likely to smoke marijuana than those in the 0-36-month group (26.3% and 21.2% vs. 4.2%, respectively). Mean testicular weight and volume across the cohort were 60.1 ± 24.9 grams and 65.5 ± 41.1 cm, respectively. Spermatogenesis was present in 28.2% (n = 24) of specimens with active spermatogenesis noted in 8.2% (n = 7). Hyalinization, scarring/fibrosis, and atrophy were present in 28.2% (n = 24), 20.0% (n = 17), and 25.9% (n = 22) of specimens, respectively. There were no differences in pathology parameters across the GAHT groups. Testicular weight and volume were not associated with any differences in pathology parameters. Additionally, age was not associated with testicular weight, volume, or pathology parameters with the exception of the following: when patients were categorized as either ≤40 years of age (n = 48) vs. > 40 years of age (n = 37), patients who were older were more likely to have hyalinization (43.2% vs. 16.7%) as well as atrophy (40.5% vs. 14.6%).
The duration of GAHT use was not associated with any differences in orchiectomy pathology parameters in patients undergoing gender-affirming surgery, and some patients may still have some spermatogenesis based on the parameters observed in this study.
描述接受性别确认手术的跨性别女性（使用包括雌激素和螺内酯在内的性别确认激素疗法[GAHT]）睾丸切除标本的组织病理学参数。我们的假设是，GAHT使用时间的延长会影响睾丸健康。
回顾性队列研究。
三级转诊中心。
2015年12月至2020年3月期间接受睾丸切除术（无论是否同时进行阴道成形术）的所有跨性别女性（出生时被指定为男性但自我认同为女性的个体）。
在接受睾丸切除术（无论是否同时进行阴道成形术）的患者中使用GAHT（雌激素和螺内酯）。
回顾人口统计学和围手术期数据以及病理记录。记录以下病理参数：睾丸体积、睾丸重量、生精情况（活跃与生精减少）、成熟停滞、睾丸萎缩、透明变性、瘢痕形成/纤维化以及支持细胞和间质细胞表型。将患者分为描述GAHT使用时间的三类之一：0 - 36个月、37 - 60个月和>60个月。进行描述性统计，并在GAHT组之间比较结果（人口统计学数据和病理参数）。
在研究期间，85例患者接受了睾丸切除术，其中85.9%（n = 73）同时进行了阴道成形术。该队列的平均（标准差）年龄和体重指数分别为39±16岁和28.4±5.4kg/m²。此外，虽然这无统计学意义，但37 - 60个月组和>60个月组的患者吸食大麻的可能性高于0 - 36个月组（分别为26.3%和21.2%，而0 - 36个月组为4.2%）。整个队列的平均睾丸重量和体积分别为60.1±24.9克和65.5±41.1立方厘米。28.2%（n = 24）的标本存在生精现象，其中8.2%（n = 7）观察到活跃生精。透明变性、瘢痕形成/纤维化和萎缩分别存在于28.2%（n = 24）、20.0%（n = 17）和25.9%（n = 22）的标本中。GAHT组之间的病理参数无差异。睾丸重量和体积与病理参数的任何差异均无关联。此外，年龄与睾丸重量、体积或病理参数无关联，但以下情况除外：当患者分为≤40岁（n = 48）和>40岁（n = 3）时），年龄较大的患者更易出现透明变性（43.2%对16.7%）以及萎缩（40.5%对14.6%）。
在接受性别确认手术的患者中，GAHT的使用时间与睾丸切除病理参数的任何差异均无关联，并且根据本研究观察到的参数，一些患者可能仍有一定的生精能力。
