Context. Hormonal therapy followed by orchiectomy is of the standard of care in management of gender identity disorder in patients seeking male to female transition. The orchiectomy specimens from these patients are routinely subjected to histopathologic evaluation. We discuss the spectrum of histopathologic findings, incidental findings, and cost analysis of processing these specimens. Design. Orchiectomy specimens from patients seeking male to female transition received at our institution from January 2019 to June 2021 were included in the study. Data including patient age, history of hormonal therapy, testicular weight, histopathologic findings, number of tissue sections, and processing cost were collected. Results. A total of 79 specimens were identified. Mean patient age was 36.7 ± 14.5 years. Mean testicular weight was 28.0 ± 8.3 g (right) and 27.8 ± 9.1 g (left). Histologic evaluation showed diminished or absent spermatogenesis in 100% and fibrosis of seminiferous tubules in 96% of specimens. Benign, incidental findings, none of which altered patient management were present in 6 specimens (8%). For most specimens, 3 sections per testis were submitted. This resulted in a mean of 5.8 ± 1.1 tissue sections submitted per specimen. Conclusions. Orchiectomy specimens from patients with gender dysphoria always demonstrate hormone-therapy effects albeit with varying degree. The chances of discovering any incidental finding of clinical significance are negligible. Diligent gross inspection and minimal tissue sampling with additional sampling reserved for gross abnormalities can adequately document the histologic findings in a cost-effective manner.

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RESULTS: We included 31 AUA and 20 EAU guidelines in this study. The median panel size was 19 (interquartile range [IQR]: 17; 21), including a median of 12 (IQR: 10; 14) voting and 7 (IQR: 4; 8) nonvoting members. Panel composition of voting members was largely male (median: 83.3%; IQR: 72.7%; 92.9%) and white (median: 88.2%; IQR: 83.3%; 92.9%). About one in five guideline panels did not include a single female (11; 21.6%) or racialized individual (10; 19.6%). Overall, only 11 of 617 (1.8%) voting members were racialized women. When comparing oncology and non-oncology related guidelines, female (26.4% versus 25.8%; p[0.129) and non-white representation (21.9% versus 28.4%; p[0.129) was similar. For AUA and EAU guideline panels, female representation was similar (26.1% versus 25.8%; p [0.946) whereas racialized individuals were more frequent on AUA guidelines (29.3% versus 20.9%; p[0.048).CONCLUSIONS: As in other arenas of urology (such as the general workforce and academic leadership), female and racialized individuals are underrepresented on guideline panels of the two major professional organizations. More transparency in the panel member selection process and intentional efforts to promote gender parity and diversity are needed.