Department of Gynecology, National Cancer Center Hospital, Tokyo, Japan.
Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan.
J Obstet Gynaecol Res. 2024 Nov;50(11):2019-2028. doi: 10.1111/jog.16099. Epub 2024 Oct 1.
Endometrial changes in Japanese transgender men (TGM) on testosterone use remain elucidated. This study aims to present TGM with endometrial cancer and insights from a literature review of similar cases. Furthermore, we investigated the correlation between endometrial cancer and severe obesity in TGM who underwent gender-affirming surgery.
Between July 2020 and April 2023, two groups were assessed: 2 TGM with endometrial cancer and 43 TGM without cancer who underwent gender-affirming surgery. A literature review for TGM with endometrial cancer was conducted. Clinical data were retrospectively collected, and histopathological evaluation of female genital organs was performed.
Two TGM with endometrial cancer and an additional four similar cases were identified through a literature search. These TGM had severe obesity (body mass index [BMI] ≥30 kg/m) and long-term testosterone use, indicating a possible link between endometrial cancer and these factors. Subsequently, we investigated the 43 TGM without cancer. We revealed 30% with obesity (BMI ≥25), only three cases of severe obesity (BMI ≥30), and a significant correlation between testosterone use duration and BMI in TGM without cancer. Histological examination revealed focal proliferative endometrium in 51% of cases and polycystic ovarian changes in 77%.
Our observations suggest a potential link between severe obesity, prolonged testosterone use, and endometrial cancer in transgender men. Histological changes in the female genital tract highlighted frequent focal proliferative endometrium, even under testosterone therapy. Further research should focus on larger, multi-institutional studies to confirm these findings and establish endometrial cancer screening for Japanese TGM.
关于使用睾酮的日本跨性别男性（TGM）的子宫内膜变化仍不清楚。本研究旨在报告 TGM 子宫内膜癌病例，并对类似病例的文献进行综述。此外，我们还研究了接受性别肯定手术的 TGM 中子宫内膜癌与严重肥胖之间的相关性。
在 2020 年 7 月至 2023 年 4 月期间，评估了两组 TGM：2 例患有子宫内膜癌的 TGM 和 43 例未患有癌症的 TGM，他们均接受了性别肯定手术。对 TGM 子宫内膜癌进行了文献综述。回顾性收集临床数据，并对女性生殖器官进行组织病理学评估。
通过文献检索，我们确定了 2 例患有子宫内膜癌的 TGM 和另外 4 例类似病例。这些 TGM 患有严重肥胖（体重指数 [BMI]≥30kg/m）和长期使用睾酮，表明子宫内膜癌与这些因素之间可能存在关联。随后，我们对 43 例未患有癌症的 TGM 进行了研究。我们发现 30%的患者肥胖（BMI≥25），只有 3 例为严重肥胖（BMI≥30），并且未患有癌症的 TGM 中睾酮使用时间与 BMI 之间存在显著相关性。组织学检查显示 51%的病例存在局灶性增生性子宫内膜，77%的病例存在多囊卵巢改变。
我们的观察结果表明，严重肥胖、长期使用睾酮与 TGM 中的子宫内膜癌之间可能存在关联。在接受睾酮治疗的情况下，女性生殖道的组织学变化突出表现为经常出现局灶性增生性子宫内膜。应进一步开展更大规模、多机构的研究，以证实这些发现，并为日本 TGM 建立子宫内膜癌筛查。
