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From the Journals

Study Explores Risk of Cervical Cancer in TMGD Individuals

Researchers found "no increased risk of invasive cervical cancer or high-grade cervical intraepithelial neoplasia in transmasculine and gender-diverse (TMGD) [individuals] using gender-affirming hormone therapy," but added that the findings should be interpreted with caution.

Conexiant

In a recent retrospective cohort study, researchers from Amsterdam University Medical Center investigated the risk of cervical cancer and cervical intraepithelial neoplasia in transmasculine and gender-diverse individuals undergoing testosterone treatment.

This study, which spanned from February 17, 1972, to December 3, 2018, provides valuable insight into the relationship between exogenous testosterone and cervical health in this population. Results were published in eClinicalMedicine.

The cohort included 2,095 transmasculine and gender-diverse (TMGD) individuals, with 1,200 undergoing hysterectomy and 7 participants providing cervical biopsies. The median testosterone exposure time was 1.7 years, with an interquartile range of 1.3 to 2.5 years.

No cases of cervical cancer were observed in the cohort, with a standardized incidence ratio (SIR) of 0.30 (95% confidence interval [CI] = 0–1.4), which was significantly lower than expected. Furthermore, only 5 cases of ≥ CIN2 were identified, corresponding to 0.002% of the cohort, compared to 9.5 expected cases, yielding an SIR of 0.53 (95% CI = 0.19–1.17). This suggests that TMGD individuals on testosterone did not exhibit a higher risk for cervical cancer or severe cervical dysplasia (≥ CIN2) when compared to cisgender women.

TMGD individuals who retain their uterus or postpone surgery while undergoing testosterone therapy are an increasing demographic, the study authors noted. Despite the findings, the relatively short median follow-up time in the study—coupled with limited data on human papillomavirus (HPV) infection prevalence and cervical screening—may have introduced potential bias, they added. The authors called for further studies with longer follow-up periods and comprehensive data on HPV infection and screening practices.

"...Longer follow-up studies incorporating this information are needed," wrote first study author Asra Vestering, MD, PhD, of the Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, and colleagues.

The authors declared no conflict of interest.