Spectrum of Histopathologic Findings in Transgender Men Undergoing Gender-Affirming Gynecologic Surgery Following Preoperative Androgen Therapy: A Tertiary Care Center Study.

This article focuses on the distinctive histopathologic changes observed in gynecologic surgical specimens from transgender men (transmasculine individuals assigned female at birth) undergoing gender-affirming surgery (GAS) following preoperative androgen (testosterone) therapy. In a retrospective study of 20 patients aged 16–35 years, common findings included inactive endometrium with stromal decidua-like changes, ciliated cell metaplasia, transitional and prostatic-type metaplasia in the cervix and vagina, and multicystic ovaries with follicular maturation. The prostatic-type glands and NK3 homeobox 1 (NKX3.1)-positive basal keratinocytes were uniquely present in all transgender patients but rarely seen in cisgender controls. These androgen-induced histologic alterations are predominantly benign but require awareness by pathologists to prevent diagnostic errors and improve patient management in the context of increasing gender-affirming surgeries.