MP02-18: Cardiovascular and QOL Benefits: Why Bilateral Orchiectomy Should be Offered to All Transfeminine Women (Including Those Awaiting Vaginoplasty Surgery)
Introduction: Transgender women who receive gender-affirming feminizing hormone therapy (GAHT; typically estrogen and an anti-androgen) have been shown to experience significantly higher cardiovascular disease related mortality compared to cis-men. Patients also complain of anti-androgen side effects (urinary frequency). Gender-affirming vaginoplasty (GA-V) surgery includes bilateral orchiectomy, but surgery wait times at high volume centers are 1-4 years. We hypothesized that pre-vaginoplasty gender-affirming bilateral orchiectomy (GA-BO) could offer several specific medical benefits: 1. Reduced baseline estrogen dosage, 2. Cessation of anti-androgen; 3. Greater QOL related to decreased GAHT side effects. Methods: We performed a retrospective chart review of all patients who underwent GA-BO or GA-V from 4/2017-12/2020 and compared pre- vs. post-op hormone dosages. We also administered a questionnaire to capture patient satisfaction with GAHT side effects. Results: A total of 106 patients underwent GA-BO and 64 underwent GA-V. After GA-BO, all hormone dosages decreased post-op (Figure 1): oral estradiol (-29%; p* <0.001); IM estradiol valerate (-48%; p* <0.001); and oral progesterone (-49%; p* <0.001). There was a greater decrease in hormone dosages after GA-V: oral estradiol dosage, (-44%; p* <0.001); IM estradiol valerate, (-71%; p* <0.001); and progesterone, (-55%; p* <0.03). After both GA-BO and GA-V, all patients (100%) discontinued Spironolactone (p* <0.001), and over 90% reported improved QOL related to elimination of Spironolactone’s diuretic function side effects. Conclusions: GA-BO offers transfeminine patients the benefits of significantly lower daily GAHT medications and dosages, and improved QOL related to elimination of anti-androgen side effects. Based on these findings, combined with the fact that there is typically a long wait time for GA-V and no observed negative effects of GA-BO on GA-V, we conclude that GA-BO should be offered to all transfeminine patients, either as a stand-alone procedure or as a pre-vaginoplasty surgery option. SOURCE OF Funding: Richard Onofrio, MD Research Grant
