Microscopic Findings in the Testis of Individuals Seeking Male to Female Physical Adaptation

By Dr. Ameer Hamza

The population of those who identify as transgender and gender non-binary is growing in the United States. According to most recent estimates up to 2% of the US population identifies as transgender and/or gender non-binary. Accordingly, increased number of such individuals are seeking medical care. Specifically, there has been considerable increase in the number of individuals seeking male to female physical adaptation. A systematic management approach is available for these individuals which includes hormonal therapy followed by gender reassignment surgery.

Surgery in individuals seeking male to female physical adaptation includes genital surgeries as well as non-genital procedures. Genital surgeries include vaginoplasty, clitorolabioplasty, penectomy, and orchiectomy (i.e., removal of testis). From the pathologic standpoint, the testis specimens are among the most important specimens, since most individuals seeking male to female physical adaptation are young adults, a common age for testicular cancer.

It is currently at the discretion of the institution where the orchiectomy is performed, whether to evaluate the testis histopathologically. There is limited data in the literature describing the histopathologic findings in the orchiectomy specimens of individuals seeking male to female physical adaptation.

In a recent study published in the International Journal of Surgical Pathology (Spectrum of Histologic Findings in Orchiectomy Specimens of Patients Seeking Male to Female Physical Adaptation), the authors have described the histologic changes in the testis of individual seeking male to female physical adaptation. Most changes are secondary to the hormone therapy these individuals receive and include changes such as aspermatogenesis/hypospermatogenesis (i.e., absent or decreased sperm / sperm precursors) and fibrosis / hyalinization of seminiferous tubules. The authors also describe finding incidental benign findings in 8% of specimens. In their series of 79 specimens, none had testicular cancer. They recommend sampling the testis from these individuals to evaluate the additional hormonal changes as the treatments evolve and to look for any incidental lesions.

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Article Details
Spectrum of Histologic Findings in Orchiectomy Specimens of Patients Seeking Male to Female Physical Adaptation
Christopher Jurief, DO, Sabika Sadiq, DO, Sidrah Khawar, MD, and Ameer Hamza, MD
First Published Online September 21, 2022
International Journal of Surgical Pathology

About the Author

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Dr. Hamza completed his Medical School at Quiad-e-Azam Medical College, Pakistan. He then moved to the United States and completed his AP/CP residency at St. John Hospital and Medical Center, Detroit, MI. Following residency, he did General Surgical Pathology and selective Genitourinary Pathology Fellowships at The University of Texas, MD Anderson Cancer Center.
His clinical focus is Genitourinary Pathology. His expertise also includes Gastrointestinal pathology and Thoracic pathology.
His academic interests include basic, translational, and clinical research on rare cancers as well as benign conditions, and clinical quality improvement.