Histopathologic Features of Breast Tissue From Transgender Men and Their Associations With Androgen Therapy. Issue 1 (5th December 2022)

• Record Type: Journal Article
• Authors: Wolters, Emily A; Rabe, Kimmie E; Siegel, Lianne; Butts, Jessica; Klein, Molly E
• Is Part Of: American journal of clinical pathology. Volume 159:Issue 1(2023)
• Page Start: 43
• Page End: 52
• Publication Date: 2022-12-05
• Subjects: Breast -- Transgender men -- Gender-affirming mastectomy -- Androgen therapy; Diagnosis, Laboratory -- Periodicals; Pathology -- Periodicals; 616.07
• DOI: 10.1093/ajcp/aqac123
• Languages: English
• ISSNs: 0002-9173

Abstract

Abstract: Objectives: To assess the histopathologic features of breast tissue of transgender men (TM) undergoing gender-affirming bilateral mastectomies in relation to androgen therapy (AT). Methods: We reviewed 374 transgender bilateral mastectomy cases from 2017 to 2020. Of these, 314 (84.4%) patients received preoperative AT. We compared these with 127 cases of cisgender females undergoing elective breast reduction. Results: Breast specimens from TM on AT, compared with cisgender women, showed a median higher gross percentage of fibrous tissue ( P < .001), reduced lobular density ( P = .004), higher amount of lobular atrophy ( P < .001), and lower incidence of cysts ( P < .001), apocrine metaplasia ( P < .001), calcifications ( P < .001), columnar cell change ( P = .002), and atypia ( P = .003). Each additional month of AT was associated with a 2% decrease in the odds of having nonapocrine cysts ( P = .02), a 5% decrease in the odds of having usual ductal hyperplasia ( P = .007), and a 0.14% decrease in median lobular density (95% confidence interval, –0.18 to –0.05). Conclusions: In this study, breast specimens from TM, particularly with a history of AT, had a higher proportion of fibrous tissue, fewer lobules, and a higher degree of lobular atrophy than cisgender females. Rare cases of atypia were not predicted by preoperative imaging or gross findings, supporting routine microscopic evaluation of these specimens.