The Effects of Testosterone on Cervicovaginal Cytology in Transgender and Gender-Diverse Individuals
Abstract
BACKGROUND: The Papanicolaou (Papanicolaou) test is an effective and widely used cervical cancer screening procedure. Recommendations for cervical cancer screening do not incorporate patients' gender identities nor gender-affirming hormone statuses in determining screening surveillance intervals and interpreting test results. This study assessed the association between testosterone and rates of abnormal Papanicolaou specimens and specimen adequacy by comparing testosterone-associated Papanicolaou specimens and nontestosterone Papanicolaou specimens among transgender and gender-diverse (TGD) patients.
METHODS: Retrospective electronic health record chart review of 211 TGD patients with cervixes, contributing 298 unique Papanicolaou tests, with a visit to a primary care clinic between 2012 and 2019. Primary outcomes included specimen quality (transformation zone [TZ] present, TZ absent, atrophic specimen, scant cellularity), presence of inflammation (yes/no), and cytology results (normal, abnormal, inadequate specimen). χ2 and t test were used to compare results between testosterone-associated Papanicolaou specimens (TAPS) and nontestosterone specimens (NTS).
RESULTS: A higher proportion of TAPS had missing TZ, showed atrophy, or had scant cellularity than NTPS (58.8% vs 33.5%; P < .001). In addition, a higher proportion of TAPS showed inflammation (16.0% vs 3.4%; P < .001). There was no significant difference in the proportion of abnormal results (ie, cytologic features…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 211 participants or records.
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