Endocrinological and ovarian histological investigations in assigned female at birth transgender people undergoing testosterone therapy

Borrás, A; Manau, Maria Dolors; Fàbregues, Francesc; Casals, Gemma; Saco, Adela; Halperín, Irene; Mora, Mireia; Goday, Ana; Barral, Yasmina; Carmona, Francisco

doi:10.1016/j.rbmo.2021.05.010

Cited by 21 publications

(9 citation statements)

References 45 publications

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“…An increased proportion of primordial follicles in transgender ovarian tissue compared to control suggests that testosterone therapy has a suppressive effect on follicle activation in vivo. Similar proportions of primordial follicles were found in other studies (De Roo et al, 2017, Borrás et al, 2021 but our study found a smaller proportion of primary follicles. These studies concluded that testosterone-exposed ovaries had a similar cortical follicle distribution to cisgender females.…”

Section: Discussionsupporting

confidence: 92%

The ovaries of transgender men indicate effects of high dose testosterone on the primordial and early growing follicle pool

Bailie

Maidarti

Jack

et al. 2023

Reproduction and Fertility

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Androgens are essential in normal ovarian function and follicle health but hyperandrogenism, as seen in polycystic ovary syndrome, is associated with disordered follicle development. There are few data on the effect of long-term exposure to high levels of testosterone as found in transgender men receiving gender-affirming endocrine therapy. In this study, we investigate the effect of testosterone on the development, morphological health and DNA damage and repair capacity of human ovarian follicles in vivo and their survival in vitro. Whole ovaries were obtained from transgender men (mean age: 27.6 ± 1.7 years; range 20-34 years, n = 8) at oophorectomy taking pre-operative testosterone therapy. This was compared to cortical biopsies from age-matched healthy women obtained at caesarean section (mean age: 31.8±1.5 years; range= 25-35 years, n=8). Cortical tissues were dissected into fragments and either immediately fixed for histological analysis or cultured for 6 days and subsequently fixed. Follicle classification and morphological health were evaluated from histological sections stained with H&E and expression of γH2AX as a marker of DNA damage by IHC. In uncultured tissue, testosterone exposure was associated with reduced follicle growth activation, poor follicle health and increased DNA damage. After 6 days of culture, there was enhanced follicle activation compared to control with further deterioration in morphological health and increased DNA damage. These data indicate that high circulating concentrations of testosterone have effects on the primordial and small-growing follicles of the ovary. These results may have implications for transgender men receiving gender-affirming therapy prior to considering pregnancy or fertility preservation measures.

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Section: Discussionsupporting

confidence: 92%

The ovaries of transgender men indicate effects of high dose testosterone on the primordial and early growing follicle pool

Bailie

Maidarti

Jack

et al. 2023

Reproduction and Fertility

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show abstract

“…The more recent studies with larger numbers share this limitation. 7,10–12 Borras et al compared the follicle distribution of their cohort of 70 persons to a past study reporting the follicular distribution of healthy young women and reported similar percentages of primordial, primary and secondary follicles. 13 They also reported stromal luteinization in 68.6% and rare stromal hyperplasia.…”

Section: Discussionmentioning

confidence: 96%

“…The study by Borras et al measured the mean tunica albuginea thickness of their transgender patients as 550 μm, they also lacked a control group. 11 The physical environment of the ovary, being stiff or loose, is suggested to have effect on follicular growth and differentiation. 15,16 We have observed a positive correlation between age and cortical thickness in our study.…”

Section: Discussionmentioning

confidence: 99%

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Ovarian Histology of Removed Ovaries After Gender-Affirming Testosterone Therapy

et al. 2023

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Introduction. Assigned female at birth transgender people go through a gender-affirming hormone therapy using testosterone. We aimed to define the histological changes in the removed ovaries of these patients and investigate the correlation of these changes to factors like chronological age and duration of hormone therapy. Methods. The ovaries of 84 patients who had at least 6 months of testosterone therapy before surgery were examined. Tunica albuginea thickness, cortical thickness, and number of different stages of follicles were recorded. Results. The mean age was 27.2 ± 4.9 years. Testosterone duration 25.8 ± 13.1 months. The mean tunica albuginea thickness was 356.4 ± 152.6 µm. The mean cortical thickness was 799.6 ± 245.6 µm. The number of primordial (C1) follicles was 18.03 ± 13.6 and antral (C3) follicles was 3.1 ± 1.9 per cm². When grouped as using therapy under or over 2 years the groups did not have differences in histological findings. Hormone duration did not correlate with histological findings except for a positive correlation with atretic follicle number. However, age was negatively correlated with number of follicles at all stages except atretic follicles and positively correlated with cortical thickness ( P < .05). Conclusion. Testosterone therapy induces multifollicularity, stromal hyperplasia, and luteinization in some patients. Hormone duration did not correlate with ovarian histology whereas chronological age did suggesting an effect of age on ovarian reserve rather than duration of hormone therapy.

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“…Ergebnisse Bis zu 87 % der TGD-Männer verwenden Verhütungsmittel 1 2 3 , wobei die Induktion einer Amenorrhoe ein Hauptanliegen ist 4 . Die meisten der verfügbaren Studien zeigten keine Beeinträchtigung der ovariellen Reserve durch die GAHT 5 6 7 8 9 , aber eine deutliche Wirkung auf die Spermatogenese 10 11 12 13 14 15 16 17 18 19 20 21 22 . Selbst nach Beginn der GAHT unterschied sich die Anzahl der nach ovarieller Stimulation gewonnenen Eizellen bei Transgender-Männern nicht von der altersentsprechender Frauen 23 24 25 26 27 .…”

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Kontrazeption, Fertilität und Fertilitätsprotektion bei Transpersonen unter geschlechtsangleichender Hormontherapie

Feil

Reiser

Böttcher

et al. 2023

Geburtshilfe Und Frauenheilkunde

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Endocrinological and ovarian histological investigations in assigned female at birth transgender people undergoing testosterone therapy

Cited by 21 publications

References 45 publications

The ovaries of transgender men indicate effects of high dose testosterone on the primordial and early growing follicle pool

The ovaries of transgender men indicate effects of high dose testosterone on the primordial and early growing follicle pool

Ovarian Histology of Removed Ovaries After Gender-Affirming Testosterone Therapy

Kontrazeption, Fertilität und Fertilitätsprotektion bei Transpersonen unter geschlechtsangleichender Hormontherapie

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