Histopathologic Features of Breast Tissue from Transgender Men and Their Associations with Androgen Therapy

Emily A. Wolters, Kimmie E. Rabe, Lianne Siegel, Jessica Butts, Molly E Klein

Research output: Contribution to journalArticlepeer-review


Objectives: To assess the histopathologic features of breast tissue of transgender men (TM) undergoing gender-Affirming bilateral mastectomies in relation to androgen therapy (AT). Methods: We reviewed 374 transgender bilateral mastectomy cases from 2017 to 2020. Of these, 314 (84.4%) patients received preoperative AT. We compared these with 127 cases of cisgender females undergoing elective breast reduction. Results: Breast specimens from TM on AT, compared with cisgender women, showed a median higher gross percentage of fibrous tissue (P<.001), reduced lobular density (P=.004), higher amount of lobular atrophy (P<.001), and lower incidence of cysts (P<.001), apocrine metaplasia (P<.001), calcifications (P<.001), columnar cell change (P=.002), and atypia (P=.003). Each additional month of AT was associated with a 2% decrease in the odds of having nonapocrine cysts (P=.02), a 5% decrease in the odds of having usual ductal hyperplasia (P=.007), and a 0.14% decrease in median lobular density (95% confidence interval,-0.18 to-0.05). Conclusions: In this study, breast specimens from TM, particularly with a history of AT, had a higher proportion of fibrous tissue, fewer lobules, and a higher degree of lobular atrophy than cisgender females. Rare cases of atypia were not predicted by preoperative imaging or gross findings, supporting routine microscopic evaluation of these specimens.

Original languageEnglish (US)
Pages (from-to)43-52
Number of pages10
JournalAmerican journal of clinical pathology
Issue number1
StatePublished - Jan 1 2023

Bibliographical note

Publisher Copyright:
© 2022 American Society for Clinical Pathology,.


  • Androgen therapy
  • Breast
  • Gender-Affirming mastectomy
  • Transgender men

PubMed: MeSH publication types

  • Journal Article


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