Jun 122017

There are a lot of unknowns when it comes to hormone therapy for trans people. Which androgen is best for trans men? Are there long-term risks if they don’t have their ovaries or testes removed? And can we develop a way to give trans men testosterone that doesn’t involve needles or creams? This week’s paper tried to answer one question: What happens to trans men’s uteruses with all that testosterone?

Loverro et al recruited 12 trans men in Italy to participate. After examinations making sure they didn’t have any lurking cancers that might flourish with extra testosterone, they received intramuscular testosterone therapy. On average they were on testosterone for 32 months (roughly 2.5 years) before going on to have hysterectomy/oophorectomy. The uterus and ovaries wer then examined under the microscope. Estrogen and testosterone levels were also tracked throughout the study and up to one year after surgery.

What did they find?

First — a caveat. I’m not going to present all the nitty gritty details of the results. I don’t think the percent of Ki-67 receptors found in each tissue type is useful for most people. Nor do I think the details of exactly what their hormone levels were was useful. (They were in the therapeutic ranges). So I’m keeping my analysis here at the ten thousand foot view.

Loverro et al found that the uteruses did not atrophy with testosterone. The uteruses continued to be in an active state. Several trans men had a secretory uterus. That means their uteruses were building up the lining. In cis women that’s during the phase just before ovulation (when the egg is released). In trans men who don’t menstruate it’s harder to tell what’s going on. They also found that the muscular layer in the uterus was bigger, just like all muscles get bigger with testosterone.

When they examined the ovaries, they found that most of them were large with multiple follicles. The larger size was mostly from more connective tissue (collagen). That means more stuff in between the hormone producing cells, not more hormone producing cells. Multiple follicles were also found, just like in polycystic ovarian syndrome. That is a known effect of testosterone. And just like in PCOS, the larger follicles probably caused fewer menses. All of these ovarian changes were likely an effect of the testosterone.

That’s nice and all. But what does it mean?

It’s important to know that the uterus does not atrophy. That means trans men are still at risk for endometrial and uterine cancers. We don’t have any long term information on whether trans men are at high, low, or average risk for those cancers. However trans men should definitely seek medical advice if they experience spotting, cramping, or unexplained weight loss. As always, they should follow up with a primary care provider, like a family medicine, internal medicine, or ob/gyn doctor.

Want to read the study for yourself? The abstract is publicly available.