MP02-18 CARDIOVASCULAR AND QOL BENEFITS: WHY BILATERAL ORCHIECTOMY SHOULD BE OFFERED TO ALL TRANSFEMININE WOMEN (INCLUDING THOSE AWAITING VAGINOPLASTY SURGERY)

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP02-18 CARDIOVASCULAR AND QOL BENEFITS: WHY BILATERAL ORCHIECTOMY SHOULD BE OFFERED TO ALL TRANSFEMININE WOMEN (INCLUDING THOSE AWAITING VAGINOPLASTY SURGERY) Robert Victor, Jenna Stelmar, Nance Yuan, Shannon Smith, Grace Lee, and Maurice Garcia Robert VictorRobert Victor More articles by this author , Jenna StelmarJenna Stelmar More articles by this author , Nance YuanNance Yuan More articles by this author , Shannon SmithShannon Smith More articles by this author , Grace LeeGrace Lee More articles by this author , and Maurice GarciaMaurice Garcia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003213.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Transgender women who receive gender-affirming feminizing hormone therapy (GAHT; typically estrogen and an anti-androgen) have been shown to experience significantly higher cardiovascular disease related mortality compared to cis-men. Patients also complain of anti-androgen side effects (urinary frequency). Gender-affirming vaginoplasty (GA-V) surgery includes bilateral orchiectomy, but surgery wait times at high volume centers are 1-4 years. We hypothesized that pre-vaginoplasty gender-affirming bilateral orchiectomy (GA-BO) could offer several specific medical benefits: 1. Reduced baseline estrogen dosage, 2. Cessation of anti-androgen; 3. Greater QOL related to decreased GAHT side effects. METHODS: We performed a retrospective chart review of all patients who underwent GA-BO or GA-V from 4/2017-12/2020 and compared pre- vs. post-op hormone dosages. We also administered a questionnaire to capture patient satisfaction with GAHT side effects. RESULTS: A total of 106 patients underwent GA-BO and 64 underwent GA-V. After GA-BO, all hormone dosages decreased post-op (Figure 1): oral estradiol (-29%; p*<0.001); IM estradiol valerate (-48%; p*<0.001); and oral progesterone (-49%; p*<0.001). There was a greater decrease in hormone dosages after GA-V: oral estradiol dosage, (-44%; p*<0.001); IM estradiol valerate, (-71%; p*<0.001); and progesterone, (-55%; p*<0.03). After both GA-BO and GA-V, all patients (100%) discontinued Spironolactone (p*<0.001), and over 90% reported improved QOL related to elimination of Spironolactone’s diuretic function side effects. CONCLUSIONS: GA-BO offers transfeminine patients the benefits of significantly lower daily GAHT medications and dosages, and improved QOL related to elimination of anti-androgen side effects. Based on these findings, combined with the fact that there is typically a long wait time for GA-V and no observed negative effects of GA-BO on GA-V, we conclude that GA-BO should be offered to all transfeminine patients, either as a stand-alone procedure or as a pre-vaginoplasty surgery option. Source of Funding: Richard Onofrio, MD Research Grant © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e19 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Robert Victor More articles by this author Jenna Stelmar More articles by this author Nance Yuan More articles by this author Shannon Smith More articles by this author Grace Lee More articles by this author Maurice Garcia More articles by this author Expand All Advertisement PDF downloadLoading ...