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Pfau DR, Schwartz AR, Dela Cruz C, Padmanabhan V, Moravek MB, Shikanov A. A Mouse Model to Investigate the Impact of Gender Affirming Hormone Therapy with Estradiol on Reproduction. Adv Biol (Weinh) 2023:e2300126. [PMID: 37688350 PMCID: PMC10920391 DOI: 10.1002/adbi.202300126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/21/2023] [Indexed: 09/10/2023]
Abstract
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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Affiliation(s)
- DR Pfau
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor MI 48109, USA
| | - AR Schwartz
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor MI 48109, USA
| | - C Dela Cruz
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor MI 48109, USA
| | - V Padmanabhan
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor MI 48109, USA
- Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI 48109, USA
| | - MB Moravek
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor MI 48109, USA
- Division of Reproductive Endocrinology and Infertility, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Urology, University of Michigan, Ann Arbor, MI 48109, USA
| | - A Shikanov
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor MI 48109, USA
- Program in Cellular and Molecular Biology, University of Michigan, Ann Arbor, MI 48109, USA
- Biomedical Engineering Department, University of Michigan, Ann Arbor, MI 48109, USA
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Cornejo KM, Oliva E, Crotty R, Sadow PM, Devins K, Wintner A, Wu CL. Clinicopathologic features and proposed grossing protocol of orchiectomy specimens performed for gender affirmation surgery. Hum Pathol 2022; 127:21-27. [PMID: 35660072 PMCID: PMC9489654 DOI: 10.1016/j.humpath.2022.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/23/2022] [Accepted: 05/25/2022] [Indexed: 01/17/2023]
Abstract
Gender affirmation surgery performed for gender dysphoria is increasing to instigate changes more closely approximating gender identity. We investigated the clinicopathologic features of gender-affirming orchiectomies performed at our institution and devised a grossing protocol for these increasingly encountered specimens. We obtained 45 orchiectomies from 23 patients and reviewed clinicopathologic features. The number of sections per case was noted and reviewed to devise an optimal grossing protocol to assess pathologic findings. Twenty-three patients had bilateral orchiectomy with 1 unilateral. The average patient age was 39.4 years (range, 21-71 years); all received hormones for a mean of 66.1 months (range, 12-348 months). The average number of slides per orchiectomy was 8 slides (range, 1-11). Aspermatogenesis occurred in 32 (71%), hypospermatogenesis in 8 (18%), and normal spermatogenesis in 5 (11%) testes. Twenty-five (56%) exhibited scattered cells with nuclear cytomegaly, concerning for germ cell neoplasia in situ (GCNIS), but OCT4 negative. Six (13%) had multinucleated stromal cells. Leydig cells were markedly reduced/absent in 38 testes (85%). Epithelial hyperplasia was identified in 15 rete testes (33%) and 24 epididymes (53%), while 18 (40%) showed periepididymal muscular hyperplasia. All findings were identified in the initial 2 slides including rete testis/epididymis, except for 3 cases, missing only focal tubular sclerosis. Despite all received treatment, only a subset showed changes of exogenous hormone therapy. The presence of nuclear cytomegaly can mimic GCNIS and may be a potential pitfall. Two sections to include rete testis/epididymis and a third of cord margin are sufficient to identify the relevant pathology and germ cell tumors overall are uncommon in orchiectomies performed for gender affirmation.
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Affiliation(s)
- Kristine M Cornejo
- Department of Pathology, Massachusetts General Hospital, Boston, MA, 02114, USA.
| | - Esther Oliva
- Department of Pathology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Rory Crotty
- Department of Pathology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Peter M Sadow
- Department of Pathology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Kyle Devins
- Department of Pathology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Anton Wintner
- Department of Urology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Chin-Lee Wu
- Department of Pathology, Massachusetts General Hospital, Boston, MA, 02114, USA
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Kelley JT, McMullen-Tabry ER, Skala SL. Reproductive Organ Pathology of Individuals Undergoing Gender-Affirming Surgery. Surg Pathol Clin 2022; 15:421-434. [PMID: 35715169 DOI: 10.1016/j.path.2022.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
As gender-affirming surgeries become more routine, it is increasingly important for pathologists to recognize the expected histologic changes seen in various tissues secondary to gender-affirming hormone therapy. For example, exogenous testosterone-related squamous atrophy or transitional cell metaplasia of the cervix may be confused for high-grade squamous intraepithelial lesion. In addition to distinguishing between benign and dysplastic/malignant features, pathologists should be mindful of the phrasing of their reports and aim to use objective, nongendered language.
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Affiliation(s)
- Justin T Kelley
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Emily R McMullen-Tabry
- Department of Pathology, Grand Traverse Pathology, PLLC, 1105 6th Street, Traverse City, MI 49684, USA
| | - Stephanie L Skala
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA.
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Salgado E, Romera-Baurés M, Beltran-Catalan E, Naredo E, Carreira PE, Garcia-Vivar M, Moreno-Muelas JV, Boteanu A, Calvo-Penades I, Sellas-Fernandez A, Valero M, Gomez-Reino JJ. Inmune-mediated inflammatory rheumatic diseases in transgender people: A scoping review. Semin Arthritis Rheum 2021; 52:151920. [PMID: 34872742 DOI: 10.1016/j.semarthrit.2021.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 10/25/2021] [Accepted: 10/25/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND In immune-mediated inflammatory rheumatic diseases (IMIRD), there are differences between cis-men and cis-women in epidemiology, clinical feature, therapeutic approach, treatment response, and prognosis. In transgender individuals, information concerning IMIRD is not substantial. The assessment of information concerning rheumatic diseases in transgenders is crucial because transgenders may undergo treatments with potential impacts on IMIRD. We aim to collect and discuss current knowledge on IMIRD in transgender individuals, determine the coverage of the literature, identify the knowledge gaps, and highlight opportunities for future research. METHODS We did a scoping review of publications collected through a systematic search of transgender patients with any IMIRD. Data sources were Medline, Embase, and Web of Knowledge. Synthesis of results and qualitative review of data information was collected in tables. A semi-quantification of the quality of the articles reporting clinical studies was performed. RESULTS There were 11 transwoman, and 3 transmen cases of systemic lupus erythematosus (5 cases), skin lupus erythematosus (2), systemic sclerosis (4), anti-synthetase syndrome (1), rheumatoid arthritis (1) and ankylosing spondylitis (1). Eleven were de novo cases and three had prior history of IMIRD and developed a comorbidity after starting hormone replacement therapy. The clinical expression of the disease was variable. Two transwomen and one transman developed thrombotic events. The lupus skin lesions in one transman improved following testosterone treatment. No clinical studies were identified. Quality of publications was disparate. CONCLUSION Although the number of cases is small, most cases of IMIRD occur in transwomen. The absence of solid data warrants caution in establishing recommendations regarding hormone replacement therapy in transgenders with IMIRD. There is an essential need for the consideration of cisgender and transgender particularities in future research on IMIRD.
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Affiliation(s)
- Eva Salgado
- Rheumatology Service, Complejo Hospitalario Universitario, c/ Ramon Puga Noguerol, 54, Ourense 32005 , Spain.
| | - Montserrat Romera-Baurés
- Rheumatology Service, Hospital Universitari Bellvitge, Carrer de la Feixa Llarga, s/n, Barcelona, L'Hospitalet de Llobregat 08907 , Spain
| | - Emma Beltran-Catalan
- Rheumatology Service, Hospital del Mar, Passeig Marítim de la Barceloneta, 25, 29, Barcelona 08003, Spain
| | - Esperanza Naredo
- Rheumatology Service, Hospital Universitario Fundación Jiménez Díaz, Av. de los Reyes Católicos 2, Madrid 28040, Spain
| | - Patricia E Carreira
- Rheumatology Service, Hospital Universitario Doce de Octubre, Av. de Córdoba s/n, Madrid 28041 , Spain
| | - Mariluz Garcia-Vivar
- Rheumatology Service, Hospital Universitario Basurto, Montevideo Etorb. 18, Bilbao 48013, Spain
| | - Jose V Moreno-Muelas
- Rheumatology Unit, Hospital Vall d' Hebrón, Passeig de la Vall d'Hebron 119, Barcelona 08035, Spain
| | - Alina Boteanu
- Rheumatology Service, Hospital Universitario Ramón y Cajal, M-607 km. 9, 100, Madrid 28034, Spain
| | - Inma Calvo-Penades
- Rheumatology Service, Hospital Universitario y Politécnico La Fe, Avinguda de Fernando Abril Martorell, 106, València 46026 , Spain
| | - Agusti Sellas-Fernandez
- Rheumatology Service, Hospital Universitari Arnau de Vilanova, Av. Alcalde Rovira Roure, 80, Lleida 25198, Spain
| | - Marta Valero
- Rheumatology Service, Hospital Universitario Ramón y Cajal, M-607, km. 9, 100, Madrid 28034, Spain
| | - Juan J Gomez-Reino
- Fundación IDIS, Rheumatology, Complejo Hospitalario Universitario de Santiago, Rúa da Choupana, s/n, Santiago de Compostela 15706 , Spain
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