title: Testicular Functions and Clinical Characterization of Patients with Gender Dysphoria (GD) Undergoing Sex Reassignment Surgery (SRS).
abstract: BACKGROUND
  Cross-sex hormone treatment of gender dysphoria (GD) patients changing from male to female a prerequisite for sex reassignment. For initial physical adaptation, a combined treatment of anti-androgens and estrogens is used. Provided that patients fulfill specific criteria, sex reassignment surgery (SRS) presents the final step toward physical adaptation. However, systematic studies analyzing effects of hormone treatment regimens are lacking.
  
  
  OBJECTIVE
  The aim of this study was to compare the effects of three different hormonal treatment strategies regarding endocrinological parameters and testicular histology.
  
  
  METHODS
  Testicular tissues were obtained in a multicenter study from 108 patients on the day of SRS from three clinics following different treatment strategies. Patients either discontinued treatment 6 weeks (clinic A) or 2 weeks (clinic B) prior to SRS or not at all (clinic C). Testicular tissues, ethylenediaminetetraacetic acid blood and questionnaires were obtained on the day of SRS.
  
  
  METHODS
  Blood hormone and intratesticular testosterone (ITT) levels were measured. Testicular weight and histology were evaluated and the percentage of luteinizing hormone/choriogonadotropin receptor (LHCGR) positive cells was determined.
  
  
  RESULTS
  According to the questionnaires, patients showed desired phenotypical changes including breast growth (75%) and smooth skin (32%). While patients from clinics A and B presented with rather virilized hormonal levels, patients from clinic C showed generally feminized blood serum levels. Histological evaluation revealed highly heterogeneous results with about 24% of patients presenting with qualitatively normal spermatogenesis. In accordance with serum endocrine profile, ITT levels were lowest in clinic C and correlated with testosterone and free testosterone, but not with the spermatogenic state. The percentage of LHCGR-positive cells and ITT levels did not correlate.
  
  
  CONCLUSIONS
  Only patients that did not discontinue hormonal treatment showed feminized blood levels on the day of SRS. The ones who stopped re-virilized quickly. Interestingly, testicular histology was highly heterogeneous irrespective of the treatment strategy, a phenomenon that requires further investigation.
authors.affiliation: Center of Reproductive Medicine and Andrology, Institute of Reproductive and Regenerative Biology, Muenster, Germany.|Department of Clinical Andrology, Centre of Reproductive Medicine and Andrology, Muenster, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Schneider
authors.affiliation: Center of Reproductive Medicine and Andrology, Institute of Reproductive and Regenerative Biology, Muenster, Germany.
authors.forename: Nina
authors.initials: N
authors.lastname: Neuhaus
authors.affiliation: Center of Reproductive Medicine and Andrology, Institute of Reproductive and Regenerative Biology, Muenster, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Wistuba
authors.affiliation: Department of Clinical Andrology, Centre of Reproductive Medicine and Andrology, Muenster, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Zitzmann
authors.affiliation: Department of Urology, Universitätsklinikum Essen, Essen, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Heß
authors.affiliation: Department of Urology, Asklepios Westklinikum Hamburg, Hamburg, Germany.
authors.forename: Dorothee
authors.initials: D
authors.lastname: Mahler
authors.affiliation: Department of Urology, Klinikum Osnabrück, Osnabrück, Germany.
authors.forename: Hermann
authors.initials: H
authors.lastname: van Ahlen
authors.affiliation: Center of Reproductive Medicine and Andrology, Institute of Reproductive and Regenerative Biology, Muenster, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Schlatt
authors.affiliation: Department of Clinical Andrology, Centre of Reproductive Medicine and Andrology, Muenster, Germany.
authors.forename: Sabine
authors.initials: S
authors.lastname: Kliesch
mesh_terms: D000328:Adult; D000726:Androgen Antagonists / Q000627:therapeutic use; D004967:Estrogens / Q000627:therapeutic use; D005260:Female; D000068116:Gender Dysphoria / Q000523:psychology* / Q000601:surgery; D005858:Germany / Q000453:epidemiology; D012739:Gonadal Steroid Hormones / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D057830:Gender-Affirming Surgery / Q000379:methods*; D013091:Spermatogenesis / Q000187:drug effects*; D011795:Surveys and Questionnaires; D013737:Testis / Q000503:physiopathology* / Q000601:surgery; D013739:Testosterone / Q000097:blood; D063106:Transgender Persons / Q000523:psychology*
chemical_list: D000726:Androgen Antagonists; D004967:Estrogens; D012739:Gonadal Steroid Hormones; D013739:Testosterone
keywords: Cross-Sex Hormone Therapy; Gender Dyshoria; Spermatogenesis; Steroidogenesis; Testicular Tissue; Transsexual Patients