Endocrine Abstracts

Introduction: Transgender – a common widely spread term that describes people whose gender identity does not match the sex they were assigned at birth. Transgender subjects may undergo various interventions, such as hormone therapy or gender-affirming surgeries to align their physical appearance with their gender identity.

Case report: A 49 year old biologicaly male who declaratively feels like a woman since childhood, who underwent all mandatory psychological examination to legaly change their sex from male to female comes for endocrinological examination. Patient recieved empirical hormonal terapy in the last two years but the feminizing characters are discordant in relation to the dose of hormone replacement administered. At the clinical exam patient presents with bilateral gynecomastia, higher voice, reduced facial hair, hypoplasic penis (2 cm lenght buried in the suprapubic fat pad), right testicle excision for ectopic testicles in childhood no left testicle palpable in scrotum. We raised the suspicion of ovotestis or ectopic testicle, for which an MRI examination is recommended. MRI - hypoplastic penis, the left testicle located in the pelvic subcutaneous fat, anteriorly, left paramedian, with the outline of the scrotum at this level; right testicle not visible, left kidney not visible (surgically removed in childhood). The patient’s karyotype was performed with the result was 46, XY. The good result of the patient’s feminization with hormone therapy is also generated by the testicular hypofunction. Although the patient’s karyotype is confirmed to be 46, XY, further histopathological evaluation is necessary to exclude other causes of cryptorchidism. A different result of the karyotype would have prevented the continuation of the legal transformation of the sex. In the presented case, the resection of the remaining testicle is necessary not only for the gender affirming surgery reason, but also for the risk of malignancy that the restant testicle carries.