目标:尽管定期进行性别确认激素治疗(GAHT),子宫出血偶尔会发生,并引起严重的不适。本研究旨在评估雌激素(ER)的组织学特征和免疫组织化学表达。孕酮(PR),接受睾丸激素治疗的变性男性子宫内膜和子宫肌层中的雄激素(AR)受体,并将其与临床和激素特征联系起来。
方法:回顾性横断面研究。
方法:纳入34名接受GAS的变性男性。临床,社会人口统计学,和实验室数据以及解剖病理学和免疫组织化学结果进行了评估。
结果:参与者的平均年龄为42.35(SD,10.00)年,体重指数为28.16(SD,5.52)kg/m2。术前平均GAHT持续时间为5.36(SD,3.24)年。平均睾酮水平为814.98(SD,407.13)ng/dL,雌二醇水平为55.22(SD,25.27)pg/mL。子宫内膜萎缩占61.8%,增殖性17.6%,分泌20.6%。免疫组织化学受体分析显示子宫内膜上皮细胞表达ER(90%)和PR(80%),AR的表达较低(30%)。在基质组织中,中位数ER,PR,AR的表达低于上皮(60%,70%,25%,分别)。子宫肌层显示PR(90%)和ER(70%)的高表达,AR的最高表达(65%)定位于该区域。
结论:在本研究中,GAHT在三分之二的变性男性中诱发了子宫内膜萎缩性状况,在子宫内膜区域有有限的AR表达。目前的结果表明,基于睾丸激素的GAHT平均5年在变性男性闭经中是安全的。
OBJECTIVE: Despite regular gender-affirming hormone therapy (GAHT), the presence of uterine bleeding can occur occasionally and cause profound discomfort. This study aimed to evaluate the histologic features and immunohistochemical expression of estrogen (ER), progesterone (PR), and androgen receptors (AR) in the endometrium and
myometrium of transgender men receiving testosterone therapy and relate them to clinical and hormonal characteristics.
METHODS: Retrospective cross-sectional study.
METHODS: Thirty-four transgender men undergoing gender-affirming surgery were included. Clinical, sociodemographic, and laboratory data as well as anatomopathological and immunohistochemical findings were evaluated.
RESULTS: The participants\' mean age was 42.35 (SD, 10.00) years, and body mass index was 28.16 (SD, 5.52) kg/m2. The mean GAHT duration before surgery was 5.36 (SD, 3.24) years. The mean testosterone levels were 814.98 (SD, 407.13) ng/dL, and estradiol levels were 55.22 (SD, 25.27) pg/mL. The endometrium was atrophic in 61.8%, proliferative in 17.6%, and secretory in 20.6%. Immunohistochemical receptor analysis revealed that endometrial epithelial cells expressed ER (90%) and PR (80%), with a lower expression of AR (30%). In stromal tissue, the median ER, PR, and AR expression was lower than that in the epithelium (60%, 70%, and 25%, respectively). The
myometrium showed high expression of PR (90%) and ER (70%), with the highest expression of AR (65%) being localized to this region.
CONCLUSIONS: In the present study, GAHT induced an atrophic condition of the endometrium in two-thirds of the transgender men, with a limited AR expression in the endometrial region. The present results suggest that testosterone-based GAHT for a mean of 5 years is safe in transgender men achieving amenorrhea.