Operative Complications, Vaginal Bleeding, and Practice Considerations for Patients on Testosterone Undergoing...

Area of Science:

• Reproductive Medicine
• Endocrinology
• Surgical Oncology

Background:

• Gender-affirming hysterectomy is a key component of gender affirmation for transgender individuals.
• Understanding operative risks and healthcare utilization in this population is crucial for optimizing care.
• Testosterone therapy is commonly used by transgender men and nonbinary individuals, potentially influencing surgical outcomes.

Purpose of the Study:

• To compare operative complications and healthcare utilization between transgender patients using testosterone and cisgender controls undergoing minimally invasive hysterectomy.
• To identify specific risks associated with testosterone use in the context of gender-affirming surgery.

Main Methods:

• Retrospective cohort study comparing 88 transgender patients on testosterone with 242 cisgender controls undergoing minimally invasive hysterectomy.
• Data collected on intraoperative and postoperative complications, electronic medical record (EMR) messages, phone calls, emergency department visits, and clinic visits over 90 days.
• Healthcare utilization reasons were categorized to identify trends.

Main Results:

• Testosterone users were younger, had lower BMI, and were more likely to be nulliparous.
• Increased risk of intraoperative perineal lacerations requiring repair in the testosterone group (RR 3.3).
• Higher incidence of reported vaginal bleeding via EMR or phone calls in the testosterone group (RR 1.74); increased use of postoperative vaginal estrogen.

Conclusions:

• Preoperative testosterone use may increase the risk of intraoperative vaginal laceration and postoperative vaginal bleeding reports.
• Findings support the need for enhanced preoperative counseling regarding potential surgical risks for transgender patients on testosterone.
• This evidence contributes to the ongoing understanding of the safety profile of gender-affirming hysterectomy.