Uterine changes in transgender men using testosterone

Posted October 8, 2024.

A study conducted by the INCT Hormona team at Universidade Federal do Rio Grande do Sul (UFRGS)/Hospital de Clínicas de Porto Alegre, southern Brazil, investigated the changes and transformations that can occur in the uterus of transgender men receiving testosterone therapy. The article “Uterine changes in transgender men receiving testosterone therapy” can be read in full at: https://academic.oup.com/ejendo/article-abstract/191/2/175/7720652

The primary objective of the study was to describe in detail the histological features and immunohistochemical expression of estrogen, progesterone, and androgen receptors in the endometrium and myometrium of these patients. According to Dr. Eliane Dias da Silva, the study also sought to relate the histopathological and immunohistochemical findings to the clinical and hormonal characteristics of these individuals in order to evaluate the long-term safety of gender-affirming hormone therapy (GAHT) in the endometrium.

A total of 34 transgender men participated in the study, and their clinical, sociodemographic, and laboratory data as well as anatomopathological and immunohistochemical findings were evaluated. “Those selected were monitored within the Transdisciplinary Gender Identity Program (PROTIG) and in the Division of Endocrinology of the Hospital de Clínicas de Porto Alegre (HCPA) and underwent gender-affirming surgery at HCPA, with uterine tissue samples stored in the pathology laboratory of this institution,” she explains.

After data analysis, the study concluded that, despite prolonged use of testosterone, GAHT appears to induce endometrial atrophy in most transgender men, with reduced endometrial thickness and androgen receptors showing a limited expression in the endometrium but higher in the myometrial region. “These results suggest that testosterone use for about 5 years is safe for the endometrium in transgender men achieving amenorrhea,” says the researcher.

For Dr. Eliane, the study was of great relevance for improving health care for the transgender population. “It contributes to a deeper understanding of the response to gender-affirming hormone therapy in the uterus of transgender men,” she says.

Once the study is complete, the expert believes that improving the quality of life of transgender men should always be related to continuous and individual monitoring of uterine health, aiming to identify potential complications and to adjust treatment as needed. “This is particularly important for individuals experiencing persistent bleeding or cramping even with regular use of testosterone, following current recommendations for the cisgender population,” she concludes.