Ricerc@Sapienza

Introduction: Gender dysphoria (GD) is characterised by significant distress and/or poor
social functioning due to a non-congruence between an individual’s assigned gender and the
perceived gender identity. In Female to Male subjects, androgen therapy aims to induce
physical changes (such as hair growth, tone voice decrease, fat mass redistribution, breast
volume reduction, etc) and cessation of menses. The latest guidelines (Hembree, 2017)
suggest a higher risk of malignancies (uterus and ovaries) and of endometrial hyperplasia than
cis-gender female, secondary to testosterone therapy. Therefore, a radical
hysteroannesisectomy is recommended after 2 years of therapy.
Aims: The aim of this study is the acquisition of data from pelvic ultrasound surveillance in
Transgender Male in order to evaluate endometrial thickness, uterine and ovarian volume.
Materials and Methods: FtM subjects referred to the outpatient clinic of Endocrinology and
Andrology of the Department of Experimental Medicine, “Sapienza” University of Rome, for
Gender Dysphoria, sent by their mental health specialists. We recruited 26 patients (mean age
27.3 ± 11.0) with the following inclusions criteria: diagnosis of gender dysphoria, participation
on follow-up, no previous testosterone therapy; exclusions criteria were: history of
gynaecological surgery/hysterectomy, menopause. Each patient underwent clinical
evaluation, blood testosterone test and US evaluation before starting therapy (T0) and after
six months of therapy (T 6). The hormone therapy consisted of intramuscolar testosterone
undecanoate 250 mg-every 28 days.
Results: Twenty-six subjects underwent the baseline evaluation: mean uterine volume was
49.4 ± 21.7 cc, mean endometrial thickness was 5.0 ± 3.5 mm, mean right ovarian volume was
5.9 ± 5.3 cc, mean left ovarian volume was 7.5 ± 6.8 cc and mean endometrial thickness was
5.0 ± 3.5 mm. At this time, 12 patients finished six months therapy and returned for control.
The cessation of menses occurred in all patients after a median of 2 months (approximately 2
testosterone undecanoate injections). There was no significant difference in post therapy
mean uterine volume (49.4 ± 21.7 cc vs 49.9 ± 29.0 cc, T0 vs T6, p = 0.43) and in endometrial
thickness (5.0 ± 3.5 mm vs 2.7 ± 1.0 mm, T0 vs T6, p = 0.15). Instead we detected a significant
decrease in mean left ovarian volume (7.5 ± 6.8 cc vs 2.7 ± 1.1, T0 vs T6, p = 0.002) and right
ovarian volume (5.9 ± 5.3 cc vs 2.3 ± 1.7, T0 vs T6, p =0.010). Blood tests confirmed a
significant increase of testosterone levels after six months of therapy (1.3 ± 0.9 vs 13.4 ± 4.5
nnmol/L, T0 vs T6; p=0.001). We did not detect any significant correlation between
testosterone levels under treatment and ovarian volume.
Conclusions: Testosterone therapy induces marked physical changes, as demonstrated by
menses cessation and reduction of ovarian volume, although apparently not correlated with
mean blood testosterone level. No significant difference were found in endometrial thickness
and uterine volume, though these results may be due in part to the small number of enrolled
subjects. Future increase of study cohort and longer follow up will strengthen our results and
possibly provide information on risk of malignancies in trangender males.