Presentation Authors: Tristan M. Nicholson*, Ivor Clinton, John K. Amory, Nicholas Reder, Thomas J. Walsh, Ashleigh B. Theberge, Seattle, WA
Introduction: Transgender women are individuals born with male sex characteristics who identify as female. These individuals may choose to be treated with a combination of estrogen and anti-androgen to better align their physical appearance with their gender identity. Existing literature reports variable rates of spermatogenesis in pathology specimens, limiting accurate counseling of transgender women about their fertility potential. Therefore, our goal was to evaluate spermatogenesis in pathologic specimens from transgender women on gender-affirming hormone therapy at the time of bilateral simple orchiectomy.
Methods: Following IRB approval, transgender women who underwent gender-confirming orchiectomy from 2011-2018 were identified in the Department of Pathology archives. A retrospective medical records review was performed to gather clinical information. Pathology reports were reviewed for specimen weight, dimensions of testes and description of spermatogenesis. To compare continuous variables, Students t-test was used.
Results: 52 transgender women who underwent bilateral simple orchiectomy were identified (mean age 38 years, SD 13, range 22-66). All were socially transitioned (living as women); 40 of 52 (77%) were listed as female gender in the medical record and patients were on gender-affirming hormone therapy for a mean of 2.4 years (SD 2, range 1-10). Intact spermatogenesis was reported in 13.5%, hypo-spermatogenesis in 23.1%, no spermatogenesis in 51.9% and spermatogenesis was not reported in 11.5% of testis specimens. There was no difference in estimated testis volume among testes found to have some spermatogenesis (mean 30 cc, SD 15) versus no spermatogenesis (mean 22 cc, SD 7, p = .10).
Conclusions: While a substantial proportion of transgender individuals do desire future fertility, historically, the reproductive needs of these patients have been largely ignored. Our study demonstrates that in testis tissue from transgender women on gender affirming hormone therapy, some (23.1%) or intact spermatogenesis (13.5%) is present at the time of bilateral simple orchiectomy. This finding has important implications for counseling transgender women about their reproductive potential.