Effects of Estrogen on Spermatogenesis in Transgender Women

Da David Jiang, Erica Swenson, Malachi Mason, Kevin R. Turner, Daniel D. Dugi, Jason C. Hedges, Sarah L. Hecht

Research output: Contribution to journalArticle

Abstract

Objective: To characterize spermatogenesis in the estrogenized transgender patient. Materials and Methods: This is a retrospective, single-center, cross-sectional study. Seventy-two transgender women underwent gender-affirming orchiectomy between May 2015 and January 2017. All were on long-term (>1 year) cross-sex hormonal therapy prior to orchiectomy. Patient data were obtained via chart review. Histologic analysis was performed by a pathology resident under the supervision of a genitourinary pathologist. The main outcome is histologic presence of germ cells and presence of spermatids (a proxy for preserved spermatogenesis) in orchiectomy specimens. Results: There were 141 pathologic specimens available for analysis. Germ cells were present in 114 out of 141 (81%) testicles. Spermatids were present in 57 (40%) testicles. Presence of germ cells was associated with older age (43 vs 35 years, P = .007) and increased testicular weight (28.6 g vs 19.3 g, P <.001). Presence of spermatids was associated with increased weight (31.5 g vs 23.3 g, P <.001) and volume (20.3 mL vs 12.6 mL, P <.001). There was a linear correlation between testis volume and preserved spermatogenesis (Pearson's r = 0.448, P <.001). Conclusion: Despite long-term hormone therapy, the majority (80%) of transgender women have germ cells present in the testicle. Spermatogenesis is preserved in approximately 40% of these individuals. Duration of hormonal therapy did not affect the degree of preservation of germ cells or spermatogenesis but starting hormonal treatment at a younger age may be associated with decreased germ cells in the testicle. Volume of testicles predict presence of preserved spermatogenesis.

Original languageEnglish (US)
Pages (from-to)117-122
Number of pages6
JournalUrology
Volume132
DOIs
StatePublished - Oct 2019

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Transgender Persons
Spermatogenesis
Germ Cells
Testis
Estrogens
Spermatids
Orchiectomy
Weights and Measures
Proxy
Therapeutics
Cross-Sectional Studies
Hormones
Pathology

ASJC Scopus subject areas

  • Urology

Cite this

Effects of Estrogen on Spermatogenesis in Transgender Women. / Jiang, Da David; Swenson, Erica; Mason, Malachi; Turner, Kevin R.; Dugi, Daniel D.; Hedges, Jason C.; Hecht, Sarah L.

In: Urology, Vol. 132, 10.2019, p. 117-122.

Research output: Contribution to journalArticle

Jiang, Da David ; Swenson, Erica ; Mason, Malachi ; Turner, Kevin R. ; Dugi, Daniel D. ; Hedges, Jason C. ; Hecht, Sarah L. / Effects of Estrogen on Spermatogenesis in Transgender Women. In: Urology. 2019 ; Vol. 132. pp. 117-122.
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abstract = "Objective: To characterize spermatogenesis in the estrogenized transgender patient. Materials and Methods: This is a retrospective, single-center, cross-sectional study. Seventy-two transgender women underwent gender-affirming orchiectomy between May 2015 and January 2017. All were on long-term (>1 year) cross-sex hormonal therapy prior to orchiectomy. Patient data were obtained via chart review. Histologic analysis was performed by a pathology resident under the supervision of a genitourinary pathologist. The main outcome is histologic presence of germ cells and presence of spermatids (a proxy for preserved spermatogenesis) in orchiectomy specimens. Results: There were 141 pathologic specimens available for analysis. Germ cells were present in 114 out of 141 (81{\%}) testicles. Spermatids were present in 57 (40{\%}) testicles. Presence of germ cells was associated with older age (43 vs 35 years, P = .007) and increased testicular weight (28.6 g vs 19.3 g, P <.001). Presence of spermatids was associated with increased weight (31.5 g vs 23.3 g, P <.001) and volume (20.3 mL vs 12.6 mL, P <.001). There was a linear correlation between testis volume and preserved spermatogenesis (Pearson's r = 0.448, P <.001). Conclusion: Despite long-term hormone therapy, the majority (80{\%}) of transgender women have germ cells present in the testicle. Spermatogenesis is preserved in approximately 40{\%} of these individuals. Duration of hormonal therapy did not affect the degree of preservation of germ cells or spermatogenesis but starting hormonal treatment at a younger age may be associated with decreased germ cells in the testicle. Volume of testicles predict presence of preserved spermatogenesis.",
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AB - Objective: To characterize spermatogenesis in the estrogenized transgender patient. Materials and Methods: This is a retrospective, single-center, cross-sectional study. Seventy-two transgender women underwent gender-affirming orchiectomy between May 2015 and January 2017. All were on long-term (>1 year) cross-sex hormonal therapy prior to orchiectomy. Patient data were obtained via chart review. Histologic analysis was performed by a pathology resident under the supervision of a genitourinary pathologist. The main outcome is histologic presence of germ cells and presence of spermatids (a proxy for preserved spermatogenesis) in orchiectomy specimens. Results: There were 141 pathologic specimens available for analysis. Germ cells were present in 114 out of 141 (81%) testicles. Spermatids were present in 57 (40%) testicles. Presence of germ cells was associated with older age (43 vs 35 years, P = .007) and increased testicular weight (28.6 g vs 19.3 g, P <.001). Presence of spermatids was associated with increased weight (31.5 g vs 23.3 g, P <.001) and volume (20.3 mL vs 12.6 mL, P <.001). There was a linear correlation between testis volume and preserved spermatogenesis (Pearson's r = 0.448, P <.001). Conclusion: Despite long-term hormone therapy, the majority (80%) of transgender women have germ cells present in the testicle. Spermatogenesis is preserved in approximately 40% of these individuals. Duration of hormonal therapy did not affect the degree of preservation of germ cells or spermatogenesis but starting hormonal treatment at a younger age may be associated with decreased germ cells in the testicle. Volume of testicles predict presence of preserved spermatogenesis.

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