Objective: Gender affirming treatment in transgender individuals may involve gender affirming hormonal therapy. The effects on spermatogenesis in transgender women (TW) remain unclear. Earlier studies have documented variable results regarding germ cell maturation and testicular function in this population, which may be ascribable to the variable degree of testosterone suppression. In order to add information from a referral center for transgender care, we wish to compare results of earlier studies with our population of TW who received a standard hormone treatment. Design: Prospective cohort study Setting: Part of the European Network for the Investigation of Gender Incongruence (ENIGI). Patients: Ninety-seven transgender women who initiated hormonal therapy (HT) with cyproterone acetate (CPA) plus estrogens, according to the ENIGI protocol and who proceeded with gonadectomy at the Ghent University Hospital, Belgium, were selected. Interventions: Testicular tissue retrieved during gonadectomy was processed and stained for four different germ cell markers by the Biology of the Testis lab at the Vrije Universiteit Brussel, Belgium. Main Outcome Measures: Subsequent immunohistochemical staining was performed for melanoma-associated antigen A4 (MAGE-A4), BOLL, cAMP responsive element modulator (CREM), and acrosin. The number of MAGE-A4+ spermatogonia and primary spermatocytes were counted per square millimeter. Serum levels of sex steroids were measured prior to surgery. Results: Adequately suppressed testosterone levels (< 50ng/dl) were found in ninety-two procent (89/97) of the participants prior to surgery. The mean time between initiation of HT and surgery was 685 days. In 88% (85/97) of the sections, MAGE-A4 staining was positive. Further immunohistochemical staining could not reveal complete spermatogenesis in any of the participants. There was a positive correlation between serum testosterone levels and number of spermatogonia counted per mm². Conclusion: Adequate HT leads to complete suppression of spermatogenesis in most transgender women, if serum testosterone levels within female reference ranges are obtained. Therefore, it is important to discuss sperm preservation before the start of hormone therapy, as stated in the WPATH guidelines. However, in TW in whom serum testosterone levels remain higher, continuous or restored spermatogenesis may occur.
|Number of pages||11|
|Publication status||Published - Jan 2021|