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Volume 25, Issue 3 (May 2023) 25, 309–313; 10.4103/aja202262

Serum estradiol levels decrease after oophorectomy in transmasculine individuals on testosterone therapy

Sahil Kumar1,2, Elise Bertin2, Cormac O Dwyer1,2, Amir Khorrami1,2, Richard Wassersug2, Smita Mukherjee2, Neeraj Mehra3, Marshall Dahl4, Krista Genoway2,5, Alexander G Kavanagh2,6

1 Faculty of Medicine, University of British Columbia, Vancouver V6T 1Z4, British Columbia, Canada
    2 Gender Surgery Program, Vancouver Coastal Health, Vancouver V5Z 1M9, British Columbia, Canada
    3 Department of Obstetrics and Gynecology, University of British Columbia, Vancouver V6T 1Z4, British Columbia, Canada
    4 Division of Endocrinology, Department of Medicine, University of British Columbia, Vancouver V6T 1Z2, British Columbia, Canada
    5 Division of Plastic and Reconstructive Surgery, University of British Columbia, Vancouver V5Z 1M9, British Columbia, Canada
    6 Department of Urologic Sciences, University of British Columbia, Vancouver V5Z 1M9, British Columbia, Canada

Correspondence: Dr. AG Kavanagh (gsp.research@ubc.ca)



    Transmasculine individuals, considering whether to undergo total hysterectomy with bilateral salpingectomy, have the option to have a concomitant oophorectomy. While studies have evaluated hormone changes following testosterone therapy initiation, most of those patients have not undergone oophorectomy. Data are currently limited to support health outcomes regarding the decision to retain or remove the ovaries. We performed a retrospective chart review of transmasculine patients maintained on high-dose testosterone therapy at a single endocrine clinic in Vancouver, British Columbia, Canada. Twelve transmasculine individuals who underwent bilateral oophorectomy and had presurgical and postsurgical serum data were included. We identified 12 transmasculine subjects as controls, who were on testosterone therapy and did not undergo oophorectomy, but additionally matched to the first group by age, testosterone dosing regimen, and body mass index. There was a statistically significant decrease in the estradiol levels of case subjects postoophorectomy, when compared to presurgical estradiol levels (P = 0.02). There was no significant difference between baseline estradiol levels between control and case subjects; however, the difference in estradiol levels at follow-up measurements was significant (P = 0.03). Total testosterone levels did not differ between control and case subjects at baseline and follow-up (both P > 0.05). Our results demonstrate that oophorectomy further attenuates estradiol levels below what is achieved by high-dose exogenous testosterone alone. Correlated clinical outcomes, such as impacts on bone health, were not available. The clinical implications of oophorectomy versus ovarian retention on endocrinological and overall health outcomes are currently limited.
    Keywords: estradiol; gender-affirming surgery; hysterectomy; oophorectomy; testosterone therapy; transmasculine

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Asian Journal of Andrology CN 31-1795/R ISSN 1008-682X  Copyright © 2023  Shanghai Materia Medica, Chinese Academy of Sciences.  All rights reserved.