Testosterone induces distinct cellular changes in female reproductive organs—including prostate-like tissue in the vagina, uterine atrophy, cyst-filled ovaries, and male-pattern cells in the cervix.
A 2025 study1 retrospectively reviewed histopathology slides from 20 trans-identifying females (ages 16–35) who underwent “gender-affirming” gynecologic surgery following 4–63 months of testosterone therapy (mean duration 21.7 ± 17.8 months).
Key findings included:
- 100% showed NKX3.1-positive basal keratinocytes in the cervix (a marker normally found in male prostate tissue)
- 55% and 60% of cervical samples showed transitional and prostatic-type metaplasia (cell changes resembling male urethral and prostate tissue)
- 100% and 50% of vaginal samples showed the same respective patterns
- 75% had an inactive uterine lining (endometrium)
- 55% showed ciliated cell metaplasia (development of hair-like cells typically not present)
- 65% had stromal expansion and decidua-like change (tissue patterns resembling early pregnancy)
- 70% had numerous cystic follicles in the ovaries, and 60% showed signs of follicular maturation
- One patient had ovarian endometriosis; one had a mucinous cyst adenofibroma
- Fallopian tubes had paratubal mesonephric remnants, but no hypertrophy (enlargement)
A comparison group of 25 benign hysterectomy samples from females of reproductive age showed no transitional or prostatic-type metaplasia, and only 2 cases (8%) had focal NKX3.1 positivity.
- Bakshi, N., Nanda, B., Rao, S., Badwal, S., & Dhawan, S. (2025). Spectrum of Histopathologic Findings in Transgender Men Undergoing Gender-Affirming Gynecologic Surgery Following Preoperative Androgen Therapy: A Tertiary Care Center Study. International journal of surgical pathology, 10668969251363990. Advance online publication. https://doi.org/10.1177/10668969251363990 ↩︎