Summary

Dartmouth doctors combined 17 published studies on what the womb and ovaries look like under the microscope after transmasculine people took testosterone and then had them removed. The womb lining was roughly half thin and inactive and half still growing, and a few (3%) showed signs of recent ovulation despite testosterone. About 2.3% had precancerous thickening of the lining and one person had a tiny cancer. No ovarian cancers were reported, though about a third had ovaries that looked polycystic (full of small cysts). The authors concluded testosterone does not raise precancer risk, and routine biopsies before surgery are not needed without other risk factors. This is useful descriptive data, but it cannot measure risk: there was no comparison group, the studies were small and often biased, average testosterone use was only about 2.5 years, and the cancer comparison was indirect.

Key findings

• 该综述纳入了17项观察患者的研究（没有试验），从658条记录中挑选，检索至2021年4月5日。
• 在522份子宫内膜中，254份（49%）薄而不活跃，243份（47%）仍在增生，16份（3%）显示近期排卵，因此睾酮并不能可靠地使子宫内膜静止。
• 12名患者（2.3%）有子宫内膜的癌前增厚，1名（0.2%）同时有一小处癌；其中九例发生在没有出血的人身上。
• 在410名患者（765个卵巢）中，143人（35%）的卵巢看起来是多囊性的，3人（0.7%）有无害的增生物，没有报告卵巢癌。
• 5.6%的患者卵巢中发现了近期排卵的迹象，这表明使用睾酮期间排卵可能继续；作者强调需要避孕。
• 其他无害的发现包括：子宫肌瘤12.5%，子宫内膜息肉7.3%，子宫内膜长入子宫肌层2.7%，与子宫内膜异位症相关的卵巢囊肿1.2%。
• 睾酮的平均使用时间约为30个月，大多数研究被评为有中到高的误导风险。
• 作者的结论是，睾酮不会增加子宫癌前病变的风险，也不需要仅仅因为某人使用睾酮就在手术前做活检。

Abstract

PURPOSE: The objective of this systematic review was to evaluate the effects of testosterone on uterine and ovarian pathology in transmasculine patients at the time of gender-affirming surgery.

METHODS: Searches were conducted using MEDLINE, CINAHL with Full Text, Cochrane Library, Scopus, and Europe PMC for articles published before April 5, 2021, containing concepts of testosterone use, uterine histopathology, and transgender population. The initial search yielded a total of 658 abstracts. Studies were analyzed in full text if they reported one or more uterine or ovarian histopathological findings in a noncisgender population receiving testosterone for gender affirmation. Rayyan software was used for the abstract review.

RESULTS: This review was registered with PROSPERO. Twenty-eight full-text articles were reviewed, of which 17 met the inclusion criteria. Two reviewers performed data extraction and risk of bias assessment. Thirteen studies included endometrial histopathology results, representing 522 patients. Endometrial findings demonstrated that 254 patients (48.7%) were atrophic, 243 (46.6%) were proliferative, and 16 (3.0%) were secretory. Twelve patients (2.3%) had endometrial intraepithelial neoplasia (EIN), including one (0.2%) with focal adenocarcinoma. Eleven studies reported ovarian histopathology in 410 patients and 765 ovaries. A total of 143 (34.9%) patients had polycystic-appearing ovaries. Three (0.7%) patients had benign ovarian neoplasms. No ovarian malignancies were reported.

CONCLUSION: The endometrium was predominately found to be atrophic or proliferative, with low rates of EIN and carcinoma. No ovarian malignancy was observed. Based on this review, patients on testosterone do not have an increased risk of precancerous endometrial lesions due to unopposed hormones in the setting of amenorrhea.

Conclusion

The endometrium was predominately found to be atrophic or proliferative, with low rates of EIN and carcinoma. No ovarian malignancy was observed. Based on this review, patients on testosterone do not have an increased risk of precancerous endometrial lesions due to unopposed hormones in the setting of amenorrhea. (Full-text conclusion adds: a minority had secretory endometrium, supporting evidence that ovulation can occur on testosterone; benign lesions such as fibroids and endometriosis occur and symptoms should be evaluated as in cisgender patients.)