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Effects of hormone therapy in patients who underwent male-to-female gender confirmation surgery

  • Trishul Kapoor
  • Joseph Banuelos
  • Todd B. Nippoldt
  • Pedro Ciudad
  • Jorys Martinez-Jorge
  • Oscar J. ManriqueEmail author
Original Paper

Abstract

Background

An estimated 1.4 million transgender individuals currently reside in the USA and this patient population is increasing on an annual basis (Am J Public Health 107: 1–8, 2017). Along with this census increase, there has also been an increasing number of gender confirmation surgeries being performed in the USA (American Society of Plastic Surgeons, 2016). Our primary objective was to study the effects of hormonal therapy on testicular volumetrics on transgender patients who underwent male-to-female (MtF) bottom gender confirmation surgery.

Methods

Retrospective review of patients who underwent MtF bottom gender confirmation surgery. Based on World Professional Association for Transgender Health (WPATH) guidelines a minimum of 1 year of hormonal therapy was required in order to be included. Two groups were analyzed based on their hormone therapy regimen (estrogen and estrogen/progesterone). Demographics, comorbidities, body mass index (BMI), medications (and length of use), testicular volumetrics (weight, length of spermatic cord, volume), and post-operative complications (dehiscence, seroma, hematoma, infection, return to the OR) were analyzed.

Results

A total of 54 patients were analyzed. The mean age of the sample population was 37.7 (± 13.3) years old. The mean difference in BMI before and after hormonal treatment was − 0.14 (± 1.7) in the estrogen only group and + 0.3 (± 1.7) in the estrogen/progesterone (combined) group (p = 0.396). The mean weight of surgical specimens in the estrogen only and in the combined group was 30.2 (± 14.9) and 24.1 (± 8.7), respectively (p = 0.033). The spermatic chord length for patients in the estrogen group was 5.4 cm (± 1.7), and 4.5 cm (± 1.6) for patients in the combined group (p = 0.009). Of all the patients, 18 presented with minor wound dehiscence of labia majora. Analysis of complications regarding to the type of hormonal therapy they received showed no difference among patients in the estrogen only and the combined group (p = 0.859).

Conclusion

Hormone therapy is an integral aspect of a multidisciplinary approach to transgender medicine and surgery. Further studies are required to elucidate systemic effects in detail and evaluate outcomes in a post-operative setting.

Level of Evidence: Level III, risk /prognostic study.

Keywords

Transgender Hormone therapy Orchiectomy Gender confirmation surgery 

Notes

Funding

None.

Compliance with ethical standards

Conflict of interest

Trishul Kapoor, MD; Joseph Banuelos, BA; Todd B. Nippoldt, MD; Pedro Ciudad, MD; Jorys Martinez-Jorge, MD; Oscar J. Manrique, MD do not have any conflict of interest.

Informed consent

Informed consent waiver was obtained from the institutional board review for this retrospective study and the study was deemed to be of minimal risk.

References

  1. 1.
    Meerwijk EL, Sevelius JM (2017) Transgender population size in the United States: a meta-regression of population-based probability samples. Am J Public Health 107:1–8CrossRefGoogle Scholar
  2. 2.
    American Society of Plastic Surgeons 2016 Complete plastic surgery statistics report. Available at: https://www.plasticsurgery.org/documents/News/Statistics/2016/plastic-surgery-statistics-full-report-2016.pdf
  3. 3.
    Manrique OJ, Adabi K, Martinez-Jorge J, Ciudad P, Nicoli F, Kiranantawat K (2018) Complications and patient-reported outcomes in male-to-female vaginoplasty – where are we today: a systematic review and meta-analysis. Ann Plast Surg 80:684–691CrossRefGoogle Scholar
  4. 4.
    Radix A, Sevelius JM, Deutsch MB (2016) Transgender women, hormonal therapy and HIV treatment: a comprehensive review of the literature and recommendations for best practices. J Int AIDS Soc 19:208–210CrossRefGoogle Scholar
  5. 5.
    Sevelius JM (2013) Gender affirmation: a framework for conceptualizing risk behavior among transgender women of color. Sex Roles 68:675–689CrossRefGoogle Scholar
  6. 6.
    Hembree WC, Cohen-Kettins P, Delemarre-van de Waal HA et al (2009) Endocrine treatment of transsexual persons: an endocrine society clinical practice guideline. J Clin Endocrine Metabol 94:3132–3154CrossRefGoogle Scholar
  7. 7.
    Coleman E, Bockting W, Botzer M, Cohen-Kettenis P et al (2011) Standards of care for the health of transsexual, transgender, and gender-nonconforming people. Int J Transgend 13:165CrossRefGoogle Scholar
  8. 8.
    Hembree WC, Cohen-Kettenis PT, Gooren L et al (2017) Endocrine treatment of gender-dysphoric/gender-incongruent persons: an endocrine society clinical practice guideline. J Clin Endocrine Metabol 103:3869–3903CrossRefGoogle Scholar
  9. 9.
    Quinn VP, Nash R, Hunkeler E et al (2017) Cohort profile: study of transition, outcomes and gender (STRONG) to assess health status of transgender people. BMJ Open 7:1–13CrossRefGoogle Scholar
  10. 10.
    Coleman E, Bockting W, Botzer M, Cohen-Kettenis P, DeCuypere G, Feldman J, Fraser L, Green J, Knudson G, Meyer WJ, Monstrey S, Adler RK, Brown GR, Devor AH, Ehrbar R, Ettner R, Eyler E, Garofalo R, Karasic DH, Lev AI, Mayer G, Meyer-Bahlburg H, Hall BP, Pfaefflin F, Rachlin K, Robinson B, Schechter LS, Tangpricha V, van Trotsenburg M, Vitale A, Winter S, Whittle S, Wylie KR, Zucker K (2012) Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7. Int J Transgend 13:165–232CrossRefGoogle Scholar
  11. 11.
    Knudson G, De Cuypere G, Bockting W (2010) Recommendations for revision of the DSM diagnoses of gender identity disorders: consensus statement of the World Professional Association for Transgender Health. Int J Transgend 12:115–118CrossRefGoogle Scholar
  12. 12.
    De Vries ALC, McGuire JK, Steensma TD et al (2014) Young adult psychological outcome after puberty suppression and gender reassignment. Pediatrics 134:696–704CrossRefGoogle Scholar
  13. 13.
    De Vries ALC, Steensma TD, Doreleijers TAH et al (2011) Puberty suppression in adolescents with gender identity disorder: a prospective follow-up study. J Sex Med 8:2276–2283CrossRefGoogle Scholar
  14. 14.
    Beckwith N, Reisner SL, Zaslow S, Mayer KH, Keuroghlian AS (2017) Factors associated with gender-affirming surgery and age of hormone therapy initiation among transgender adults. Transgend Health 2:156–164CrossRefGoogle Scholar
  15. 15.
    Rotondi NK, Bauer GR, Scanlon K et al (2013) Nonprescribed hormone use and self-performed surgeries: “do-it-yourself” transitions in transgender communities in Ontario, Canada. Am J Public Health 103:1830–1836CrossRefGoogle Scholar
  16. 16.
    Garofalo R, Deleon J, Osmer E, Doll M, Harper GW (2006) Overlooked, misunderstood and at-risk: exploring the lives and HIV risk of ethnic minority male-to-female transgender youth. J Adolesc Health 38:230–236CrossRefGoogle Scholar
  17. 17.
    Grant JM, Mottet LA, Tanis J et al (2011) Injustice at every turn: a Report of the National Transgender Discrimination Survey. National Center for Transgender Equality, and the National Gay and Lesbian Task Force, Washington D.C.Google Scholar
  18. 18.
    Mepham N, Bouman WP, Arcelus J, Hayter M, Wylie KR (2014) People with gender dysphoria who self-prescribe cross-sex hormones: prevalence, sources, and side effects knowledge. J Sex Med 11:2995–3001CrossRefGoogle Scholar
  19. 19.
    Sanchez NF, Sanchez JP, Danoff A (2009) Health care utilization, barriers to care, and hormone usage among male-to-female transgender persons in New York City. Am J Public Health 99:713–719CrossRefGoogle Scholar
  20. 20.
    De Haan G, Santos GM, Arayasirukul S et al (2015) Non-prescribed hormone use and barriers to care for transgender women in San Francisco. LGBT Health 2:313–323CrossRefGoogle Scholar
  21. 21.
    Manrique OJ, Sabbagh MD, Ciudad P, Martinez-Jorge J, Kiranantawat K, Sitpahul N, Nippoldt TB, Charafeddine A, Chen HC (2018) Gender-confirmation surgery using the pedicle transverse colon flap for vaginal reconstruction: a clinical outcome and sexual function evaluation study. Plast Reconstr Surg 141:767–771CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Mayo Clinic, Department of SurgeryDivision of Plastic SurgeryRochesterUSA
  2. 2.Mayo Clinic, Department of MedicineDivision of EndocrinologyRochesterUSA
  3. 3.Department of Plastic and Reconstructive SurgeryChina Medical University HospitalTaichungTaiwan

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