MP35-16 DOES FEMINIZING HORMONE THERAPY REDUCE ACE2 RECEPTOR EXPRESSION?: A HISTOLOGIC STUDY USING TRANSGENDER WOMEN’S TESTICLE TISSUE AFTER ORCHIECTOMY, AND, IMPLICATIONS FOR POSSIBLE USE FOR COVID19 TREATMENT AND/OR PREVENTION

Abstract

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Prostate & Genitalia (MP35)1 Sep 2021MP35-16 DOES FEMINIZING HORMONE THERAPY REDUCE ACE2 RECEPTOR EXPRESSION?: A HISTOLOGIC STUDY USING TRANSGENDER WOMEN’S TESTICLE TISSUE AFTER ORCHIECTOMY, AND, IMPLICATIONS FOR POSSIBLE USE FOR COVID19 TREATMENT AND/OR PREVENTION John M. Masterson, Chau Bui, Yi Zhang, Xiaopen Yuan, Carissa Huynh, Harneet Jawanda, Wohaib Hasan, Daniel Luthringer, Warren Tourtellotte, and Maurice Garcia John M. MastersonJohn M. Masterson More articles by this author , Chau BuiChau Bui More articles by this author , Yi ZhangYi Zhang More articles by this author , Xiaopen YuanXiaopen Yuan More articles by this author , Carissa HuynhCarissa Huynh More articles by this author , Harneet JawandaHarneet Jawanda More articles by this author , Wohaib HasanWohaib Hasan More articles by this author , Daniel LuthringerDaniel Luthringer More articles by this author , Warren TourtellotteWarren Tourtellotte More articles by this author , and Maurice GarciaMaurice Garcia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002044.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Invasion of cells by SARS-CoV-2 is mediated by the ACE2 receptor (ACE2r), which is highly expressed in testicle tissue. It has been proposed that men hospitalized with COVID19 be treated with estrogen (E) or E and Progesterone (P), however results of these trials remain unknown. Transgender women (TW) (male to female) are routinely treated with E or E+P regimens for feminization. We analyzed differences in ACE2r expression in testicles of TW taking E or E+P. METHODS: Orchiectomy specimens were collected from TW undergoing gender-affirming surgery, who were taking E or E+P preoperatively. For controls, we used benign orchiectomy specimens from cis-gender men. All specimens were stained with H&E, Trichrome (fibrosis), insulin-liken3 antibody (INS) (Leydig cell), and ACE2r IHC. Cells per high-powered field (HPF) were counted by cell type (Leydig, Sertoli, Germ). Stain intensity was rated on a 0-2 scale. IHC scoring was performed in a blinded fashion by a senior GU Pathologist. Mean cell type/HPF and stain intensity were compared across cohorts using Student’s t-test (p<0.05). Intracohort findings were stratified by age (< or >40). RESULTS: On IHC for Leydig cells and ACE2r staining the EP cohort had fewer Leydig cells compared to controls. The EP cohort also had greater degree of tissue fibrosis compared to controls and the E cohort. On intra-cohort analysis, TW >age 40 had lower Sertoli cell (H&E, ACE2r) and Germ cell (ACE2r) counts, and lower ACE2r stain intensity on Leydig cells. The EP cohort of TW >age 40 also showed increased fibrosis to TW age <age 40. (Table 1) CONCLUSIONS: These findings have implications both for use of feminizing hormones to treat COVID19 in men and for TW seeking to preserve fertility after prolonged hormone therapy. Regarding COVID19: this work supports the hopeful possibility that a short course of P (or E+P) could downregulate ACE2r to protect men from COVID19 infection. Of separate interest to transitioning TW, this work suggests that fertility preservation after E+P may be challenging, given the significant seminiferous tubule fibrosis observed. Furthermore, E+P has the benefit of appearing to decrease endogenous Testosterone production more than E alone. Source of Funding: n/a © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e633-e633 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information John M. Masterson More articles by this author Chau Bui More articles by this author Yi Zhang More articles by this author Xiaopen Yuan More articles by this author Carissa Huynh More articles by this author Harneet Jawanda More articles by this author Wohaib Hasan More articles by this author Daniel Luthringer More articles by this author Warren Tourtellotte More articles by this author Maurice Garcia More articles by this author Expand All Advertisement PDF downloadLoading ...