Effects of hormone therapy in patients who underwent male-to-female gender confirmation surgery

  • Trishul Kapoor
  • Joseph Banuelos
  • Todd B. Nippoldt
  • Pedro Ciudad
  • Jorys Martinez-Jorge
  • Oscar J. ManriqueEmail author
Original Paper



An estimated 1.4 million transgender individuals currently reside in the USA and this patient population is increasing on an annual basis (Am J Public Health 107: 1–8, 2017). Along with this census increase, there has also been an increasing number of gender confirmation surgeries being performed in the USA (American Society of Plastic Surgeons, 2016). Our primary objective was to study the effects of hormonal therapy on testicular volumetrics on transgender patients who underwent male-to-female (MtF) bottom gender confirmation surgery.


Retrospective review of patients who underwent MtF bottom gender confirmation surgery. Based on World Professional Association for Transgender Health (WPATH) guidelines a minimum of 1 year of hormonal therapy was required in order to be included. Two groups were analyzed based on their hormone therapy regimen (estrogen and estrogen/progesterone). Demographics, comorbidities, body mass index (BMI), medications (and length of use), testicular volumetrics (weight, length of spermatic cord, volume), and post-operative complications (dehiscence, seroma, hematoma, infection, return to the OR) were analyzed.


A total of 54 patients were analyzed. The mean age of the sample population was 37.7 (± 13.3) years old. The mean difference in BMI before and after hormonal treatment was − 0.14 (± 1.7) in the estrogen only group and + 0.3 (± 1.7) in the estrogen/progesterone (combined) group (p = 0.396). The mean weight of surgical specimens in the estrogen only and in the combined group was 30.2 (± 14.9) and 24.1 (± 8.7), respectively (p = 0.033). The spermatic chord length for patients in the estrogen group was 5.4 cm (± 1.7), and 4.5 cm (± 1.6) for patients in the combined group (p = 0.009). Of all the patients, 18 presented with minor wound dehiscence of labia majora. Analysis of complications regarding to the type of hormonal therapy they received showed no difference among patients in the estrogen only and the combined group (p = 0.859).


Hormone therapy is an integral aspect of a multidisciplinary approach to transgender medicine and surgery. Further studies are required to elucidate systemic effects in detail and evaluate outcomes in a post-operative setting.

Level of Evidence: Level III, risk /prognostic study.


Transgender Hormone therapy Orchiectomy Gender confirmation surgery 




Compliance with ethical standards

Conflict of interest

Trishul Kapoor, MD; Joseph Banuelos, BA; Todd B. Nippoldt, MD; Pedro Ciudad, MD; Jorys Martinez-Jorge, MD; Oscar J. Manrique, MD do not have any conflict of interest.

Informed consent

Informed consent waiver was obtained from the institutional board review for this retrospective study and the study was deemed to be of minimal risk.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Mayo Clinic, Department of SurgeryDivision of Plastic SurgeryRochesterUSA
  2. 2.Mayo Clinic, Department of MedicineDivision of EndocrinologyRochesterUSA
  3. 3.Department of Plastic and Reconstructive SurgeryChina Medical University HospitalTaichungTaiwan

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