Abstract
Disclosure: J.C. Coleman-Belin: None. T. Reisman: None. Background: While hematospermia (visible blood in ejaculate) is most frequently benign, etiology includes idiopathic, infection, prostate disease, iatrogenic, obstruction, systemic disorders, and (rarely) malignancy. The incidence and prevalence of hematospermia in transgender women is unknown. Clinical Course: A 35-year-old transgender woman treated with estradiol valerate and leuprolide presents with persistent hematospermia and two years of intermittent hematuria. She does not report dysuria, urgency, frequency, or gastrointestinal symptoms and is a lifetime nonsmoker. Chlamydia, gonorrhea, and HIV tests are negative. CT scan 4/2021, cytoscopy 5/2021, and MRI prostrate 7/2022 (with and without IV contrast) were unremarkable. Transrectal ultrasound 9/2022 reveals 17cc prostate and posterior cyst with hemorrhagic products. Two ultrasound-guided transperineal biopsy samples obtained from the cystic structure 11/2022 reveal benign prostatic tissue with a small focus of endometrial-type epithelium (positive immunostains for PAX 8 and ER in epithelium and CD10 in stroma). These findings may indicate endometriosis or a Müllerian cyst. Discussion: The prevalence of endometrial tissue in transgender woman has not been described. Risk factors for endometriosis in AMAB* individuals are hypothesized to include prolonged estrogen exposure, cirrhosis, or chronic post-procedural inflammation(1). Because transgender women are routinely treated with extended estrogen-containing regimens, it is of interest to determine if the presence of endometrial tissue is more common than previously thought. Guidelines for management of benign endometrial-type epithelium in transgender women are lacking, including whether ectopic endometrial tissue should be excised due to concern for malignant transformation(2). Conclusion: Hematospermia in transgender women on GAHT** may indicate occult Müllerian epithelial tissue growth. *AMAB: Assigned Male at Birth **GAHT: Gender-Affirming Hormone Therapy References: 1. Rei C, Williams T, Feloney M. Endometriosis in a Man as a Rare Source of Abdominal Pain: A Case Report and Review of the Literature. Case Rep Obstet Gynecol. 2018 Jan 31;2018:2083121. doi: 10.1155/2018/2083121. PMID: 29670782; PMCID: PMC5833878. 2. Robinson, K.A., Menias, C.O., Chen, L. et al. Understanding malignant transformation of endometriosis: imaging features with pathologic correlation. Abdom Radiol 45, 1762–1775 (2020). https://doi.org/10.1007/s00261-019-01914-7 Presentation: Saturday, June 17, 2023