The Effects of Testosterone on Cervicovaginal Cytology in Transgender and Gender-Diverse Individuals
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. 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). χ A higher proportion of TAPS had missing TZ, showed atrophy, or had scant cellularity than NTPS (58.8% vs 33.5%; Findings confirmed an association between testosterone usage and cytology specimen adequacy and quality. No association was found between testosterone usage and rates of abnormal results within our TGD population. More research is needed to disentangle the effect of missing TZ on risk of future cervical dysplasia among this younger population.