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

• 回顧納入 17 項觀察患者的研究（沒有試驗），從 658 筆紀錄中挑選，檢索至 2021 年 4 月 5 日。
• 在 522 個子宮內膜中，254 個（49%）薄且不活躍，243 個（47%）仍在增生，16 個（3%）顯示近期排卵，因此睪固酮並不能可靠地使子宮內膜靜止。
• 12 名患者（2.3%）有子宮內膜癌前增厚，1 人（0.2%）有增厚並伴有一小處癌症；其中 9 例是沒有出血的人。
• 在 410 名患者（765 個卵巢）中，143 人（35%）的卵巢看起來呈多囊性，3 人（0.7%）有良性腫塊，沒有卵巢癌的報告。
• 5.6% 的患者卵巢中發現近期排卵的跡象，顯示使用睪固酮期間仍可能持續排卵；作者強調需要避孕。
• 其他良性發現包括 12.5% 有肌瘤、7.3% 有子宮內膜息肉、2.7% 有子宮內膜長入子宮肌層，以及 1.2% 有與子宮內膜異位症相關的卵巢囊腫。
• 睪固酮的平均使用時間約為 30 個月，多數研究被評為有中至高的誤導風險。
• 作者的結論是，睪固酮並不會提高子宮癌前病變的風險，而且不需要僅因為某人服用睪固酮就在手術前做切片。

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.)