465 Gynecologic pathology identified in surgical pathology specimens of transmasculine individuals—an institutional experience

Abstract Introduction/Objective Physiologic changes in the gynecologic tract of transmasculine individuals have been reported in the literature. However, reports of gynecologic pathology in transmasculine individuals are limited. In this case series, we report gynecologic pathologic findings in transmasculine individuals, identified in surgical pathology specimens of gender-affirming (GA) and non-GA procedures. Methods/Case Report The departmental pathology database was searched for gynecologic specimens of transmasculine individuals on testosterone therapy. The indication of the procedure and the pathologic findings of the surgical pathology specimens were recorded. Results 162 cases of gynecologic specimens were identified from 159 transmasculine individuals (average age at the time of surgery=31 years) from 2017—2024. 45 patients had pathologic findings, while 114 patients did not have significant pathologic findings identified. Of the 45 cases with pathologic findings, 2 cases were malignant (primary and metastatic endometrial carcinomas), 6 cases were of squamous dysplasia, and 37 cases were benign—including leiomyomas (n = 19), endometrial/cervical polyps (n = 6), ovarian mature cystic teratomas (n = 3), endometriosis (n = 2), serous cystadenoma (n = 1) and others (abscess, hemangioma, lipoma, etc.) Conclusion This study reports rare, but clinically significant pathologic findings in the gynecologic tract of transmasculine individuals. These results highlight the importance of accurate documentation of prior GA surgical status and continued gynecologic medical care for the transmasculine patient population.