Spectrum of findings in orchiectomy specimens of persons undergoing gender confirmation surgery

Matoso, Andrés; Khandakar, Binny; Yuan, Songyang; Wu, Trueman; Wang, Li J.; Lombardo, Kara; Mangray, Shamlal; Mannan, Abul Ala Syed Rifat; Yakirevich, Evgeny

doi:10.1016/j.humpath.2018.03.007

Cited by 63 publications

(66 citation statements)

References 23 publications

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“…The use of immunohistochemical markers (lutropin-choriogonadotropic hormone receptor (LHCGR), smooth muscle actin (SMA), vimentin (VIM), sal like protein 4 (SALL 4), melanoma-associated antigen 4 (MAGE A4), DEAD-box helicase 4 DDX4/VASA) revealed that the expression patterns in trans women were identical and in agreement with the staining pattern in samples from non-transgender men [48]. This finding was confirmed by others [21,22].…”

Section: Testicular Tissues and Steroidogenesis In Our Cohort Of Tsupporting

confidence: 60%

“…The results varied from spermatogenic suppression with a hyalinized basal membrane and a decreased Leydig cell function to a heterogeneous picture regarding the spermatogenic state (Figure 2) [36]. In a recent US publication examining 99 transgender testes, a decreased diameter of seminiferous tubules and expansion of the interstitium, marked hypoplasia of germ cells, hypoplasia or absence of Leydig cells, and epididymal hyperplasia were found [21]. Another publication from Thailand examining 173 testicular tissues stated that feminizing hormonal treatment before GCS results in abnormalities of germ cell development and loss of reproductive functions [22].…”

Section: Testicular Tissues and Steroidogenesis In Our Cohort Of Tmentioning

confidence: 99%

“…Evaluating spermatogenesis in a larger group of transgender patients (238 testes, Figure 2) over six years up to today, we evaluated 39 testicular tissues with complete spermatogenesis, 63 with meiotic arrest, 95 with spermatogonial arrest, and 41 with Sertoli cell only syndrome (SCO) or tubular shadows applying a systematic scoring scheme [47]. In the publication of Matoso et al, out of 99 testicular tissues, 80% showed spermatogenic defects with maturation arrest at the spermatogonial stage [21]. The remaining 20% had marked hypospermatogenesis with few and focal spermatids.…”

Section: Testicular Tissues and Steroidogenesis In Our Cohort Of Tmentioning

confidence: 99%

“…This leads to testicular regression associated with low levels of serum androgens and suppression of spermatogenesis. After several weeks GCHT interrupts germ cell differentiation at the pre-meiotic stage [20,21,22]. Byne et al concluded that counselling with regard to fertility protection/preservation should therefore start prior to initiation of GCHT [23].…”

Section: Introductionmentioning

confidence: 99%

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Options for Fertility Treatments for Trans Women in Germany

Schneider¹,

Scheffer²,

Dabel³

et al. 2019

JCM

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Fertility preservation in trans women is a crucial but thus far neglected component in the gender confirming treatment in Germany. It is difficult for trans women to access reproductive health care because centers offering treatment, psychological guidance, gender confirming surgery, as well as reproductive health services are scarce in Germany. Legal, social, or financial issues as well as individual patient comorbidities prevent trans women from receiving appropriate counselling. This review provides an overview on options of fertility preservation in trans women. We consider recent publications on testicular regression at the time of gender confirming surgery demonstrating presence of sperm or at least spermatogonia in the majority of tissues. This may open options for cryopreservation of sperm or testicular stem cells in trans women even at the final stage of transition. Hence, standardized urological procedures (i.e., sperm cryopreservation after masturbation or sperm extraction from the testicular tissue) and experimental approaches (cryopreservation of testicular tissue with undifferentiated spermatogonia) can be offered best at the initiation but also during the gender confirming process. However, counselling early in the gender confirming process increases the chances of fertility preservation because gender confirming hormone therapy has an impact on spermatogenesis.

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Section: Testicular Tissues and Steroidogenesis In Our Cohort Of Tsupporting

confidence: 60%

Section: Testicular Tissues and Steroidogenesis In Our Cohort Of Tmentioning

confidence: 99%

Section: Testicular Tissues and Steroidogenesis In Our Cohort Of Tmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Options for Fertility Treatments for Trans Women in Germany

Schneider¹,

Scheffer²,

Dabel³

et al. 2019

JCM

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show abstract

“…After they are transfixed, testicles and spermatic cords are subsequently removed. Specimens are sent for histopathological examination (Matoso et al, 2018). Meticulous hemostasis is achieved diathermically.…”

Section: Surgical Technique and Considerationsmentioning

confidence: 99%

Orchiectomy in transgender individuals: A motivation analysis and report of surgical outcomes

Sluis

Steensma

Bouman

2020

International Journal of Transgender Health

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Background: Different surgical procedures are available for transgender women wishing to undergo genital gender-affirming surgery. Aim: To assess preoperative motivations, the frequency of orchiectomy procedures, and postoperative outcomes of orchiectomy in transgender individuals. Methods: All transgender individuals who underwent orchiectomy in the period between January 2012 and January 2020 at our institution were retrospectively identified. A chart study was conducted, recording motivations, demographics, perioperative characteristics and surgical outcomes. The frequency of orchiectomy and vaginoplasty procedures during the study period were determined and compared. Results: During the study period, an increase of performed orchiectomy procedures was observed. The orchiectomy/vaginoplasty ratio was 0.01-0.07 in the period 2012-2018 and 0.24 in 2019. A total of 43 transgender individuals were retrospectively identified. Sixteen (37%) initially wished to undergo a vaginoplasty, but did not meet institutional requirements (nonsmoker, BMI < 30kg/m 2) or were not eligible for vaginoplasty surgery because of interfering somatic or mental health issues. Fourteen (33%) individuals who underwent orchiectomy regarded it as a preceding step to a future vaginoplasty procedure. Out of these fourteen, one person is now on the waiting list for vaginoplasty surgery. Thirteen (30%) others did not report a desire to pursue vaginoplasty in the future. This was mostly motivated by the absence of genital dysphoria or motivations related to their gender identity, with a desire to discontinue anti-testosterone treatment. The postoperative course was uncomplicated in 39 (91%) individuals. Conclusion: In the Netherlands, especially in the last year, the frequency of orchiectomy procedures has increased. Reasons that people chose to undergo this procedure include: not being eligible for a vaginoplasty procedure, seeing it as a preceding step to a possible future vaginoplasty or other identity-related motivations (i.e., non-binary gender identification or absence of genital dysphoria).

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A Mouse Model to Investigate the Impact of Gender Affirming Hormone Therapy with Estradiol on Reproduction

Pfau,

Schwartz,

Dela Cruz

et al. 2023

Advanced Biology

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Gender‐affirming hormone therapy (GAHT) can help transgender and/or gender diverse (TGD) individuals achieve emobidment goals that align with their transition needs. Clinical evidence from estradiol (E)‐GAHT patients indicate widespread changes in tissues sensitive to E and testosterone (T), particularly in the reproductive system. Notably, E‐GAHTs effects on hormones and reproduction vary greatly between patients. With the goal of informing clinical research and practice for TGD individuals taking E, this study examines intact male mice implanted with capsules containing one of three different E doses (low 1.25 mg; mid 2.5 mg; high 5 mg), or a blank control capsule. All E‐GAHT doses suppress T and follicle stimulating hormone levels while elevating E levels. Only the high E‐GAHT dose significantly supresses luteinizing hormone levels. All E‐GAHT doses affect epididymis tubule size similarly while seminiferous tubule morphology and bladder weight changes are dose‐dependent. E‐GAHT does not alter the presence of mature sperm, though E‐exposed sperm have altered motility. These data represent the first evidence that mouse models offer an effective tool to understand E‐GAHTs impact on reproductive health and the dose‐dependent effects of this model permit examinations of diverse patient outcomes.

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Spectrum of findings in orchiectomy specimens of persons undergoing gender confirmation surgery

Cited by 63 publications

References 23 publications

Options for Fertility Treatments for Trans Women in Germany

Options for Fertility Treatments for Trans Women in Germany

Orchiectomy in transgender individuals: A motivation analysis and report of surgical outcomes

A Mouse Model to Investigate the Impact of Gender Affirming Hormone Therapy with Estradiol on Reproduction

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