Gender Dysphoria Disrupting the Course of Treatment of a Recurrent Juvenile Granulosa Cell Tumor in an Adolescent Female: A Case Report

Abstract

We present the case of an adolescent female patient with gender dysphoria (GD) who was diagnosed with a recurrent ovarian neoplasm – juvenile granulosa cell tumor (JGCT). The 17-year-old female patient presented multiple endocrine pathologies and a recurrent JGCT. During the surgery qualification process, the patient admitted having identified herself as a male. The patient reported being uncomfortable with her body and with the expected roles of her assigned gender. Due to that, the patient requested a total hysterectomy with a bilateral salpingo-oophorectomy. As a minor, she required the permission of her parents, which was not granted. The patient underwent several specialist consultations, after which she agreed to the unilateral removal of tumor-changed pathologies and additional hormonal, psychological, and psychiatric diagnostics. To the best of our knowledge, this is the first detailed report of co-occurrence of GD spectrum disorders and JGCT in an adolescent female. This case contains many therapeutic and ethical problems regarding both physical and mental health. It should be noted that adolescents with GD spectrum rarely develop persistent transsexuality. Modulations from developmental psychology, psychotherapy, family dynamics, hormonal treatment, and the removal of JGCT in the presented case may have potential therapeutic implications for GD.

Cancer screening and management in the transgender population: Review of literature and special considerations for gender affirmation surgery

“…Other articles noted the lack of knowledge about the long-term effects of oophorectomy at the time of a hysterectomy and how oophorectomies affect the quality of life, gender dysphoria, and the risk reduction of ovarian cancer in the TGNC population[ 67 , 68 , 73 , 75 ]. Kwiatkowska et al [ 76 ] emphasizes the responsibility of the physician during hormone therapy, in which that gender-affirming surgeries must be beneficial for the overall well-being of the patient, which continues to remain a gray area due to the lack of research about the impact of hormone therapy on the risk of ovarian cancer and the benefits of prophylactic bilateral salpingo-oophorectomy in TGGD individuals using hormone therapy[ 76 ].…”