Hysterectomy and bilateral salpingoophorectomy in female-to-male transsexual: does testosterone induce anatomopatological changes? A retrospective study

Background: Testosterone replacement treatment as part of gender reassignment therapy has repercussions on the final pathological result of the hysterectomies that are performed. The objective of this review is to analyze the surgical pieces of hysterectomies performed on FTM patients (female-to-male) and to describe possible changes related to testosterone. There are few studies and with a low number of patients where this possible repercussion is addressed. Methods A retrospective study was carried out, which included 117 patients between the ages of 21 and 56, operated on between 2010 and 2019, with at least an average duration of treatment of 5 years before gender reassignment surgery. Main outcome measure were changes in follicle stimulating hormone (FSH), luteinizin hormone (LH), testosterone (TST) and estradiol in blood, both preoperatively and postoperatively. Also the differente types of endometrium and ovaries found in histerectomy pieces. Results the pathological study revealed that 95 (80.3%) cases showed an atrophic endometrium, 7 (6%) cases an endometrium with secretory-type changes, and 15 (13.7%) cases with weakly proliferating endometrium. Conclusions Our data revealed that the most frequent histology after chronic administration of parenteral testosterone was such compatible with atrophic endometrium, coinciding with what has been published in the literature up to now. More long-term studies on the effects of parenteral testosterone are still needed.