Spermatogenesis Abnormalities following Hormonal Therapy in Transwomen

To measure spermatogenesis abnormalities in transwomen at the time of sex reassignment surgery (SRS) and to analyze the association between hormonal therapy duration and infertility severity.

Retrospective study.

University hospital.

One-hundred seventy-three transwomen who underwent SRS from January 2000 to December 2015.

All orchidectomy specimens were retrospectively reviewed and classified. History of hormonal therapy duration was retrieved from medical records.

Histological examinations of orchidectomy specimens were performed to assess spermatogenesis.

One-hundred seventy-three orchidectomy specimens were evaluated. Histological examinations showed maturation arrest in 36.4%, hypospermatogenesis in 26%, Sertoli cell-only syndrome in 20.2%, normal spermatogenesis in 11%, and seminiferous tubule hyalinization in 6.4% of the specimens. Spermatogenesis abnormality severity was not associated with the total therapy duration (P = 0.81) or patient age at the time of surgery (P = 0.88). Testicular volumes and sizes were associated with spermatogenesis abnormality severity (P = 0.001 and P = 0.026, right testicle and left testicle, resp.).

Feminizing hormonal treatment leads to reductions in testicular germ cell levels. All transwomen should be warned about this consequence, and gamete preservation should be offered before starting hormonal treatment.