Abstract
INTRODUCTION:Hormonal treatment is a critical aspect of health care for transgender and nonbinary patients, but scientific literature describing ovarian and uterine histopathology in the setting of testosterone therapy remains limited and conflicted.METHODS:After IRB approval and patient consent, uterine and ovarian histopathology was prospectively evaluated in 22 gender-diverse patients on testosterone compared with 21 premenopausal cisgender controls not on hormones undergoing hysterectomy.RESULTS:Average duration of testosterone administration was 54.9 months. Average age was 30 years in the testosterone group and 40.6 years in the control group. Average body mass index was 28 kg/m2 in the testosterone group and 31 kg/m2 in the control group. 18 (82%) patients in the testosterone group had inactive/atrophic endometria, compared with 2 (10%) in the control group. 4 (18%) patients in the testosterone group had proliferative endometria, compared to 10 (48%) in the control group. No patients on testosterone had secretory endometrium, compared to 6 (29%) in the control group. Leiomyoma were noted for 5 (23%) in the testosterone group and 4 (19%) in the control group. Adenomyosis was present in 1 (5%) in the testosterone group, compared to 5 (24%) in the control group. Low rates of preoperative cervical dysplasia were reported in both groups. All cervical and fallopian tube specimens in both groups were benign.CONCLUSION:Compared to a cisgender control group, patients on long-term testosterone therapy were more likely to have inactive/atrophic endometrium. Increasing our knowledge of the effects of testosterone has implications for preoperative surgical assessment and surveillance for patients not undergoing surgery.