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Patients with gender dysphoria are offered cross-sex hormone therapy and sex reassignment surgery to achieve the transition between the sex assigned at birth and gender identity. According to international guidelines, cross-sex hormone therapy in trans-women should lead to a psychologically and physiologically healthy body with feminized serum hormone levels, resulting in suppression of spermatogenesis. However, in a recently published multi-center study, we discovered a high proportion of patients with male serum hormone levels and qualitatively intact spermatogenesis on the day of sex reassignment surgery. The objective of this study was to review the content of 11 publications that focus on the influence of cross-sex hormone therapy on testicular morphology. These publications were identified based on a PubMed search for the key words transgender/transsexual/gender dysphoria in male-to-female persons, cross-sex hormone therapy, and testicular tissues. Whereas three publications described a marked reduction of the spermatogenic level in all patients examined, eight publications reported inconsistent results. Histological analyses showed highly variable outcomes from qualitatively normal spermatogenesis and undisturbed Leydig/Sertoli cell morphology to full testicular regression with severe cellular damage and hyalinization. Explanations for these heterogeneous findings include insufficient cross-sex hormone therapy regarding dosage or duration. As complete spermatogenesis is associated with virilized serum hormone levels, these patients may face challenges especially after sex reassignment surgery in adjusting to the abruptly established hypogonadal state following removal of the testes. These findings also suggest that contraception should be discussed, and fertility preservation should be offered during/prior to cross-sex hormone therapy. There is a need for more individualized and better-controlled cross-sex hormone therapy and post-treatment regimens. Evidence-based guidelines for attending clinicians need to be established in order to deliver the most appropriate care.
F Schneider, and
S Kliesch, and
S Schlatt, and
N Neuhaus
May 2015,
Fertility and sterility,
F Schneider, and
S Kliesch, and
S Schlatt, and
N Neuhaus
August 2004,
Neurology,
F Schneider, and
S Kliesch, and
S Schlatt, and
N Neuhaus
December 2010,
Fertility and sterility,
F Schneider, and
S Kliesch, and
S Schlatt, and
N Neuhaus
February 2011,
Experimental and clinical endocrinology & diabetes : official journal, German Society of Endocrinology [and] German Diabetes Association,
F Schneider, and
S Kliesch, and
S Schlatt, and
N Neuhaus
August 2011,
Handchirurgie, Mikrochirurgie, plastische Chirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Handchirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Mikrochirurgie der Peripheren Nerven und Gefasse : Organ der V...,
F Schneider, and
S Kliesch, and
S Schlatt, and
N Neuhaus
April 2005,
Archives of sexual behavior,
F Schneider, and
S Kliesch, and
S Schlatt, and
N Neuhaus
July 2010,
Nihon Geka Gakkai zasshi,
F Schneider, and
S Kliesch, and
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N Neuhaus
December 1988,
Annals of plastic surgery,
F Schneider, and
S Kliesch, and
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N Neuhaus
September 2009,
Atherosclerosis,
F Schneider, and
S Kliesch, and
S Schlatt, and
N Neuhaus
May 2022,
The Journal of urology,
