Anatomic and Histologic Changes of the Testis after Long-Term Estrogen Exposure in Transsexuals

Park, Jung min; Ok, Yun chul; Sohn, Ho sung; Jung, Gyung woo; Kim, Seok kwun

Abstract

PURPOSE
To investigate the anatomic and histologic changes of testis as a result of long-term estrogen exposure on male
MATERIALS AND METHODS
Fourteen testes were harvested from 14 consecutive male-to-female transsexuals who had sex reassignment operation in Dong-A University Hospital from March 1991 to March 1997. Age at inception of estrogen therapy was 16 years to 24 years. The duration of estrogen therapy was 2-12 years (mean 7.4 years). The dose and method of estrogen treatment regimen was variable, but about 20 mg (intravenous) monthly during first year. Sperm analysis, volume of testis and histologic change of testis were compared to the duration of estrogen therapy.
RESULTS
The mean volume of semen was 1.8 ml(0.5~3 ml), and oligozoospermia, azoospermia or asthenospermia were observed in 12 cases (85.7%) by means of sperm analysis. The mean volume of testis was 17.3 ml(15~23ml). In light microscopic examination of the testis, near-normal histologic finding was noted in 3 cases(21.4%), spermatocytic arrest in 8 cases(57.2%) and geminal cell aplasia in 3 cases (21.4%).
CONCLUSION
As the duration of estrogen therapy was longer, there was a tendency that volume of semen, sperm count and motility were reduced and the histologic change of seminiferous tubules was severe. It was considered that the negative feedback of estrogen on hypothalamic-pituitary-gonadal axis, the down regulation of estrogen receptors and the direct effect of estrogen might produce the adverse effect on male reproductive system by testicular change with maturation arrest, germ cell aplasia, end-stage testis and peritubular fibrosis and reduced fertility after long-term estrogen exposure.