Gender affirming hormone therapy and transgender women fertility: Histologic predictors of germ cell presence

Marins, Lina Rigodanzo; Rosito, Tiago Elias; Kliemann, Lucia Maria; Capp, Edson; Corleta, Helena von Eye

doi:10.61622/rbgo/2024rbgo33

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Revista Brasileira de Ginecologia e Obstetrícia

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Original Article • Rev Bras Ginecol Obstet 46 • 2024 • https://doi.org/10.61622/rbgo/2024rbgo33 copy

Gender affirming hormone therapy and transgender women fertility: Histologic predictors of germ cell presence

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

Evaluate histological changes in testicular parameters after hormone treatment in transgender women.

Methods:

Cross-section study with patients who underwent gonadectomy at Hospital de Clínicas de Porto Alegre from 2011 to 2019. Hormone treatment type, route of administration, age at initiation and duration were recorded. Atrophy parameters were observed: testicular volume, tubular diameter, basal membrane length, presence of spermatogonia and spermatids (diploid and haploid spermatozoid precursors).

Results:

Eighty-six patients were included. Duration of hormone treatment is associated with testicular atrophy and spermatogenesis arrest. Other characteristics of hormone treatment such as age of initiation, route of administration and type of treatment were not associated with testicular histological changes. Testicular volume may predict spermatogenesis arrest. Basal membrane length and tubular diameter ratio is an interesting predictor of germ cell presence.

Conclusion:

Cross-sex hormone treatment affects testicular germ cell presence. Basal membrane length and tubular diameter ratio reduces inter variability of measurements and better exemplify how atrophic seminiferous tubules are. Fertility preservation should be addressed by healthcare providers in order to recognize gender affirming treatment impact on transgender health.

Keywords
Fertility; Hormone treatment; Spermatogenesis; Transgender women; Transgender persons; Fertility preservation; Gonadal steroid hormones

Parameter	Median	Minimum	Maximum
Age at surgery (years-old)	34.86	21	59
Age of starting GAHT (years-old)	21	14	51
GAHT duration (years)	7.5	1	34
Testicular volume (cm³)	11.7	4	51.9
Seminiferous tubular diameter (TD, µm)	162.1	73.6	967.4
Basal membrane (BM, µm)	23.8	5.5	278.53
BM/TD-ratio	10.9	3.2	50.00

Parameter		n(%)
GAHT route of administration
	Oral	47(54.7)
	Parenteral	16(18.6)
	Both	23(26.7)
Medical compound
	Estrogen + cyproterone or spironolactone	39(45.3)
	Estrogen+progestogen	17(19.8)
	Estrogen only	30(34.9)

Parameters	Spermatogonia presence	Spermatids presence
Age of initiation GAHT	0.355 (0.001)^* * Values display Sperman's correlations amongst variables described and its p-value; Significance is considered with p<0.05, marked with	0.225 (0.037)^* * Values display Sperman's correlations amongst variables described and its p-value; Significance is considered with p<0.05, marked with
Duration GAHT	0.005 (0.962)	0.067 (0.543)
Testicular volume	0.238 (0.027)^* * Values display Sperman's correlations amongst variables described and its p-value; Significance is considered with p<0.05, marked with	0.274 (0.011)^* * Values display Sperman's correlations amongst variables described and its p-value; Significance is considered with p<0.05, marked with
Tubular diameter (TD)	0.315 (0.003)^* * Values display Sperman's correlations amongst variables described and its p-value; Significance is considered with p<0.05, marked with	0.306 (0.004)^* * Values display Sperman's correlations amongst variables described and its p-value; Significance is considered with p<0.05, marked with
Basement membrane (BM)	-0.581 (<0.001)^* * Values display Sperman's correlations amongst variables described and its p-value; Significance is considered with p<0.05, marked with	-0.409 (<0.001)^* * Values display Sperman's correlations amongst variables described and its p-value; Significance is considered with p<0.05, marked with
BM/TD ratio	- 0.679 (<0.001)^* * Values display Sperman's correlations amongst variables described and its p-value; Significance is considered with p<0.05, marked with	-0.578 (<0.001)^* * Values display Sperman's correlations amongst variables described and its p-value; Significance is considered with p<0.05, marked with

Hormone treatment parameters		Tubular diameter (TD)	Basement membrane (BM)	BM/TD Ratio
Route of administration
	Oral	195.23 (135.94-266.13)	21.41 (11.14-37.64)	8.66 (5.62-22.72)
	Intramuscular	133.35 (127.00-181.03)	20.50 (12.62-38.01)	10.57 (6.32-27.22)
	Both	127.04 (106.69-247.23)	41.74 (13.09-53.50)	21.64 (7.86-41.17)
P^a a Test of Kruskal-Wallis, data presented as "median (QI25 and QI75)";		0.079	0.195	0.049
Type of hormone therapy
	Only Estrogen	171.47 (129.40-243.42)	18.61 (11.26-45.39)	9.26 (6.24-34.04)
	Estrogen and antiandrogen	165.32 (125.61-317.71)	26.26 (10.20-42.73)	10.80 (5.62-26.92)
	Combined	127.31 (115.35-198.94)	24.22 (12.16-40.44)	11.53 (7.10-26.08)
P^a a Test of Kruskal-Wallis, data presented as "median (QI25 and QI75)";		0.373	0.986	0.818
Age initiation hormone therapy^b b Spearman's correlation, data presented as "rho (P)"		0.106 (0.334)	-0.034 (0.756)	-0.095 (0.382)
Duration of hormone therapy^b b Spearman's correlation, data presented as "rho (P)"		-0.149 (0.170)	0.249 (0.021)	0.295 (0.006)

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[1] Corresponding author Lina Rigodanzo Marins E-mail: linarigodanzo@gmail.com