Histological changes in the genital tract in transsexual women following androgen therapy

Miller, Nicola; Bédard, Yvan C.; Cooter, N. B.; Shaul, David

doi:10.1111/j.1365-2559.1986.tb02520.x

Cited by 96 publications

(59 citation statements)

References 8 publications

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“…In the study, severe atrophied uterine cervix was found and variable degrees of atrophic change of endometrium were observed as well. [38] Such changes have been also observed in our previous histologic study on the extirpated uterus from 16 FTMs. (Fig.1, Fig.2) These changes are comparable with proliferative change of endometrium in PCOS.…”

Section: The Effect Of the Testosterone On Uterus And Ovarysupporting

confidence: 73%

“…Long-term testosterone use causes vaginal and cervical atrophy [3,17], with decreased vaginal secretion and difficult penetration [12].…”

Section: Masculinizing Effect In Female To Male Hormonal Therapymentioning

confidence: 99%

“…If after three months menses have not stopped, the dosage of testosterone may be increased until serum free testosterone is within upper quartile of the normal male range or menses stop. Despite endometrial atrophy, cessation of menses, and reduced fertility there is evidence of ovulation even after several years of testosterone administration [17].…”

Section: Masculinizing Effect In Female To Male Hormonal Therapymentioning

confidence: 99%

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Know-How of the Hormonal Therapy and the Effect of the Male Hormone on Uterus in the Female to Male Transsexuals

Kim¹,

Han²

2012

Hysterectomy

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Section: The Effect Of the Testosterone On Uterus And Ovarysupporting

confidence: 73%

“…Long-term testosterone use causes vaginal and cervical atrophy [3,17], with decreased vaginal secretion and difficult penetration [12].…”

Section: Masculinizing Effect In Female To Male Hormonal Therapymentioning

confidence: 99%

Section: Masculinizing Effect In Female To Male Hormonal Therapymentioning

confidence: 99%

See 1 more Smart Citation

Know-How of the Hormonal Therapy and the Effect of the Male Hormone on Uterus in the Female to Male Transsexuals

Kim¹,

Han²

2012

Hysterectomy

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“…As discussed in the introduction, long-term testosterone therapy administered intramuscularly (IM) induces vaginal and cervical atrophy that can alter Pap results and make the exam more difficult. 6,9 Vaginal and cervical atrophy in post-menopausal women results in an elevated proportion of inadequate Pap tests and is ameliorated by short-course topical estrogen cream prior to the Pap; efficacy and acceptability of this treatment in FTMs should be investigated. 26 .…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4][5][6][7][8] In addition, long-term intramuscular androgen administration induces vaginal atrophy 5,7 that may make speculum insertion more painful and cause cervical epithelial atrophy that mimics dysplasia. 9 A qualitative study with six transgender men found that "gynecologic exams are often a unique time when extreme emotional conflict between self-perceptions and physical anatomy are heightened because of physical touch," suggesting unique barriers to screening in this population. 10 No data exist regarding the prevalence of cervical cancer or cervical cancer screening among transgender men.…”

Section: Introductionmentioning

confidence: 99%

Female-to-Male Patients Have High Prevalence of Unsatisfactory Paps Compared to Non-Transgender Females: Implications for Cervical Cancer Screening

et al. 2014

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When years on testosterone therapy was added to the model, the relationship between transgender identity and Pap inadequacy was attenuated, but remained strongly associated (AOR=6.01, 95 % CI=3.00, 11.50), and time on testosterone was also associated (AOR= 1.19, 95 % CI 1.04, 1.36). FTM patients were more likely than females to have had multiple inadequate tests, and had longer latency to follow-up testing. CONCLUSIONS: The high unsatisfactory sample prevalence among FTM patients is likely due to a combination of physical changes induced by testosterone therapy and provider/patient discomfort with the exam. Clinicians should receive training in increasing comfort for FTM patients during the exam. FTM patients should be alerted that high rates of inadequate screening may require follow-up testing. Alternatives to repeated Pap testing, such as cytologic reprocessing of inadequate samples or primary human papillomavirus (HPV) DNA screening, should be studied for efficacy and acceptability among FTM patients.

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Cytomorphologic findings of cervical Pap smears from female‐to‐male transgender patients on testosterone therapy

Williams

Kukkar

Stemmer

et al. 2020

Cancer Cytopathology

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BackgroundThe cervical cancer screening recommendation for transgender female‐to‐male (FTM) patients is the same as that for cisgender females. A lack of literature on testosterone‐induced changes in cervical cytology in these patients may result in interpretation errors, especially without a proper clinical history. The aim of this study was to delineate the Papanicolaou (Pap) test findings in this patient population.MethodsA pathology laboratory information system was used to obtain a cohort of FTM transgender patients on testosterone therapy (2009‐2019). A cohort of age‐matched, atrophic, control cisgender female patients (postpartum or menopausal) was selected. A retrospective review of the cytomorphologic findings on cervical Pap smears, pertinent follow‐up, and human papillomavirus (HPV) test results was performed.ResultsFourteen transgender patients (age range, 21‐64 years; mean age, 42.5 years) receiving testosterone therapy with 17 Pap smears were identified. One of the 5 available HPV tests was positive for HPV, and 4 were negative. A Pap smear review revealed the following: negative for intraepithelial lesion (NILM; 82.4%), unsatisfactory (5.9%), atypical squamous cells of undetermined significance (ASCUS; 5.9%), and low‐grade squamous intraepithelial lesion (5.9%). The Pap smears of the atrophic cisgender cohort (102 patients) revealed the following: NILM (92.5%), unsatisfactory (0.9%), ASCUS (5.6%), and high‐grade squamous intraepithelial lesion (0.9%). The difference between the rates of epithelial cell abnormality in the 2 cohorts was not statistically significant. Although atrophy was noted in both groups, cytomorphologic findings of transitional cell metaplasia (TCM; 88.2%) and “small cells” (82.4%) were characteristic of the testosterone‐treated transgender cohort. Histologic correlates of TCM and small cells were noted in hysterectomy specimens from 6 patients.ConclusionsSmall cells and TCM are common cytomorphologic findings in Pap smears of testosterone‐treated transgender (FTM) patients. On the basis of histologic follow‐up, small cells most likely represent atrophic parabasal cells of cervical‐vaginal epithelium.

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Histological changes in the genital tract in transsexual women following androgen therapy

Cited by 96 publications

References 8 publications

Know-How of the Hormonal Therapy and the Effect of the Male Hormone on Uterus in the Female to Male Transsexuals

Know-How of the Hormonal Therapy and the Effect of the Male Hormone on Uterus in the Female to Male Transsexuals

Female-to-Male Patients Have High Prevalence of Unsatisfactory Paps Compared to Non-Transgender Females: Implications for Cervical Cancer Screening

Cytomorphologic findings of cervical Pap smears from female‐to‐male transgender patients on testosterone therapy

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