The Association between Testosterone Therapy and Postoperative Complications Among Transmen Undergoing Gender Affirming Hysterectomy

Abstract

Study Objective While there is increasing evidence on the safety of testosterone for transmen, little is known regarding its perioperative implications. This study seeks to investigate the association between testosterone and postoperative complications among transmen undergoing gender affirming hysterectomy. Design Retrospective cohort study of all gender affirming hysterectomies performed at a single teaching hospital in the United States over 26 months, with 6 weeks follow up to identify postoperative complications. Setting Standard laparoscopic operating room setup with patients in dorsal lithotomy. Patients or Participants 34 transmen on testosterone for at least 12 months before hysterectomy and continued at time of surgery. Interventions All patients underwent a total laparoscopic hysterectomy with bilateral salpingectomy Measurements and Main Results Data was collected through chart review of preoperative visits for covariates and testosterone dose and postoperative visits for complications. There were 8 postoperative complications including 6 transmen who experienced vaginal bleeding requiring application of hemostasis agents to the vaginal cuff. Mean weekly testosterone dose was 69.3mg among transmen who experienced a complication and 62.5mg among those who did not. Both groups had similar mean age (31.8 vs. 29.2), mean BMI (29.8 vs. 26.9), race (87.5% vs. 57.7% White, 12.5% vs. 26.9% Black), smoking status (12.5% vs. 19.2% current smokers), and estimated blood loss (55.7ml vs. 62.9ml). Univariable and multivariable logistic regressions were performed, adjusting for age, race, BMI, and estimated blood loss. The odds of experiencing a postoperative complication was 3% higher for every additional milligram of testosterone (OR 1.03, 95%CI 0.98-1.08). Conclusion Transmen on testosterone experience vaginal bleeding post-hysterectomy at a higher rate than reported in the literature for cis-women. While testosterone de-estrogenizes the vaginal epithelium, testosterone dose is not statistically significantly associated with postoperative complications including vaginal bleeding. Additional studies with larger samples and studies evaluating the effect of postoperative vaginal estrogen on bleeding among transmen are needed to better characterize this postoperative complication.