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Testis Morphologic Assessment in Patients undergoing Sex Reassignment Surgery with Gender Dysphoria: Case Series and Literature Review

Erica R Vormittag-Nocito, Nasma K Majeed, Manmeet Singh and John V Groth

Purpose: To study the morphologic changes to testicular architecture in response to estrogen therapy in gender dysphoric patients undergoing sexual reassignment surgery.

Materials and methods: A retrospective morphologic review of testicular architecture was performed on ten cases of male-to-female sex reassignment surgery testis from the University of Illinois Hospital and Health Sciences system. Cases were from adult males undergoing sexual reassignment surgery at the University of Illinois Hospital and Health Sciences System between 2016 and 2017. Architectural changes were measured including Leydig cell changes, basement membrane fibrosis, spermatogonia maturation, and interstitium changes.

Results: Various stages of maturation and regression were seen despite all patients being on estrogen therapy for at least one year prior to undergoing surgery.

Conclusion: There are a range of estrogen therapy-related maturation and regression effects on testicular architecture in this growing patient population. It is important for the clinician and pathologist to know these effects as benign changes related to treatment.