# In‐Depth Assessment of Cytologic Features in 106 Cervical Papanicolaou Tests of Transgender Male Patients on Testosterone: An Institutional Experience

## TL;DR

This study examines cervical cytology in transgender male patients on testosterone, finding higher unsatisfactory test rates and distinct cell features.

## Contribution

The study provides new insights into cytologic features and diagnostic challenges in cervical tests for transgender male patients on testosterone therapy.

## Key findings

- The unsatisfactory rate in FTMTG patients was significantly higher (21.7%) compared to cisgender females (2.7%).
- 78% of FTMTG CC specimens showed extensive squamous atrophy, and 67% had low cellularity.
- Features like nuclear grooves and high N:C ratio were observed in 18% and 20% of FTMTG cases, respectively.

## Abstract

There is a decreased cervical cancer screening rate among female to male transgender (FTMTG) patients. Data on the distinct cytologic features present in cervical cytology (CC) of those on testosterone therapy is limited.

An 2017–2023 electronic database search identified CC specimens from a cohort of FTMTG patients on testosterone therapy (TT). A morphologic retrospective review of CC for cellularity and presence of key morphologic features was performed. Records were reviewed for original cytologic diagnoses and concurrent HPV test results for comparison with a cisgender female (CF) cohort.

106 of 132,363 (0.08%) identified CC specimens were from FTMTG patients on TT. Diagnostic rates were compared to the CF population. The most common diagnosis for both groups was “negative for intraepithelial lesion or malignancy”. The unsatisfactory rate was significantly higher in the FTMTG cohort at 21.7% (vs. 2.7%). The comparative HPV positivity rate of FTMTG and CF cohorts was 13.2% and 10.7%, respectively. Of 83 FTMTG satisfactory CC specimens, 67% showed low cellularity (narrowly meeting the adequacy threshold of 5000 well‐visualized squamous cells) and 78% showed extensive squamous atrophy. Nuclear grooves and irregular contours (features associated with transitional cell metaplasia) were observed in 18% and 23%, respectively. High N:C ratio was noted in 20% of cases.

The higher unsatisfactory rate in FTMTG patients raises the question of whether adequacy criteria for this cohort should be adjusted. To enhance diagnostic accuracy, providing an accurate clinical history may prevent overinterpretation of features associated with transitional cell metaplasia.