Kumar Sahil, Mukherjee Smita, O'Dwyer Cormac, Wassersug Richard, Bertin Elise, Mehra Neeraj, Dahl Marshall, Genoway Krista, Kavanagh Alexander G
Faculty of Medicine, University of British Columbia, British Columbia, Canada; Gender Surgery Program of British Columbia, Vancouver Coastal Health, British Columbia, Canada.
Gender Surgery Program of British Columbia, Vancouver Coastal Health, British Columbia, Canada.
Sex Med Rev. 2022 Oct;10(4):636-647. doi: 10.1016/j.sxmr.2022.03.003. Epub 2022 Jul 10.
The transmasculine and gender diverse (TMGD) spectrum includes transgender men and non-binary individuals whose sex was assigned female at birth. Many TMGD patients pursue treatment with exogenous testosterone to acquire masculine characteristics. Some may choose to undergo gynecological gender-affirming surgery for total hysterectomy with bilateral salpingectomy and/or bilateral oophorectomy (TH/BSO). The decision to retain or remove the ovaries in the setting of chronic testosterone therapy has implications on reproductive health, oncologic risk, endocrine management, cardiovascular health, bone density and neurocognitive status. However, there is limited evidence on the long-term outcomes from this intervention.
Here we review health-related outcomes of oophorectomy in TMGD population treated with chronic testosterone therapy in order to guide clinicians and patients in the decision to retain or remove their ovaries.
We conducted a systematic literature review following PRISMA guidelines. MEDLINE, EMBASE, ClinicalTrials.gov, and Cochrane Library databases were searched for peer-reviewed studies published prior to October 26, 2021 that: (i) included transgender men/TMGD individuals in the study populations; (ii) were full-text randomized controlled studies, case reports, case series, retrospective cohort studies, prospective cohort studies, qualitative studies, and cross-sectional studies; and (iii) specifically discussed ovaries, hysterectomy, oophorectomy, ovariectomy, or gonadectomy.
We identified 469 studies, of which 39 met our inclusion criteria for this review. Three studies discussed fertility outcomes, 11 assessed histopathological changes to the ovaries, 6 discussed ovarian oncological outcomes, 8 addressed endocrine considerations, 3 discussed cardiovascular health outcomes, and 8 discussed bone density. No studies were found that examined surgical outcomes or neurocognitive changes.
There is little information to guide TMGD individuals who are considering TH/BSO versus TH/BS with ovarian retention. Our review suggests that there is limited evidence to suggest that fertility preservation is successful after TH/BS with ovarian retention. Current evidence does not support regular reduction in testosterone dosing following oophorectomy. Estradiol levels are likely higher in individuals that choose ovarian retention, but this has not been clearly demonstrated. Although bone mineral density decreases following oophorectomy, data demonstrating an increased fracture risk are lacking. No studies have described the specific impact on neurocognitive function, or changes in operative complications. Further research evaluating long-term health outcomes of oophorectomy for TMGD individuals treated with chronic testosterone therapy is warranted to provide comprehensive, evidence-based healthcare to this patient population. Sahil Kumar, Smita Mukherjee, Cormac O'Dwyer, et al. Health Outcomes Associated With Having an Oophorectomy Versus Retaining One's Ovaries for Transmasculine and Gender Diverse Individuals Treated With Testosterone Therapy: A Systematic Review. Sex Med Rev 2022;10:636-647.
跨性别男性及性别多样化（TMGD）群体包括出生时被指定为女性的跨性别男性和非二元性别者。许多TMGD患者使用外源性睾酮进行治疗以获得男性特征。一些人可能会选择接受妇科性别确认手术，即全子宫切除术加双侧输卵管切除术和/或双侧卵巢切除术（TH/BSO）。在长期睾酮治疗的情况下，保留或切除卵巢的决定会对生殖健康、肿瘤风险、内分泌管理、心血管健康、骨密度和神经认知状态产生影响。然而，关于这种干预的长期结果的证据有限。
在此，我们回顾了接受长期睾酮治疗的TMGD人群中卵巢切除术的健康相关结果，以指导临床医生和患者做出保留或切除卵巢的决定。
我们按照PRISMA指南进行了系统的文献综述。检索了MEDLINE、EMBASE、ClinicalTrials.gov和Cochrane图书馆数据库，查找2日之前发表的同行评审研究：（i）研究人群中包括跨性别男性/TMGD个体；（ii）为全文随机对照研究、病例报告、病例系列、回顾性队列研究、前瞻性队列研究、定性研究和横断面研究；（iii）具体讨论了卵巢、子宫切除术、卵巢切除术、去卵巢术或性腺切除术。
我们识别出469项研究，其中39项符合本综述的纳入标准。三项研究讨论了生育结果，11项评估了卵巢的组织病理学变化，6项讨论了卵巢肿瘤学结果，8项涉及内分泌方面的考虑，3项讨论了心血管健康结果，8项讨论了骨密度。未发现研究手术结果或神经认知变化的研究。
对于考虑进行TH/BSO与保留卵巢的TH/BS的TMGD个体，几乎没有信息可供指导。我们的综述表明，几乎没有证据表明保留卵巢的TH/BS后生育力保存成功。目前的证据不支持卵巢切除术后定期减少睾酮剂量。选择保留卵巢的个体雌二醇水平可能较高，但这尚未得到明确证实。虽然卵巢切除术后骨矿物质密度会降低，但缺乏表明骨折风险增加的数据。没有研究描述对神经认知功能的具体影响或手术并发症的变化。有必要进一步研究评估接受长期睾酮治疗的TMGD个体卵巢切除术的长期健康结果，以便为该患者群体提供全面的、基于证据的医疗保健。萨希尔·库马尔、斯米塔·穆克吉、科马克·奥德怀尔等。接受睾酮治疗的跨性别男性和性别多样化个体进行卵巢切除术与保留卵巢的健康结果：一项系统综述。《性医学评论》2022；10：636 - 647。
