Spermatogenesis Abnormalities following Hormonal Therapy in Transwomen

OBJECTIVE: 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. DESIGN: Retrospective study. SETTING: University hospital. PATIENTS: One-hundred seventy-three transwomen who underwent SRS from January 2000 to December 2015. INTERVENTIONS: All orchidectomy specimens were retrospectively reviewed and classified. History of hormonal therapy duration was retrieved from medical records. MAIN OUTCOME MEASURES: Histological examinations of orchidectomy specimens were performed to assess spermatogenesis. RESULTS: 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.). CONCLUSION(S): 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.