Does Feminizing Hormone Therapy Reduce Ace2 Receptor Expression?: A Histologic Study Using Transgender Women'S Testicle Tissue After Orchiectomy, And, Implications For Possible Use For Covid19 Treatment And/Or Prevention

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Prostate & Genitalia (MP35)1 Sep 2021MP35-16 DOES FEMINIZING HORMONE THERAPY REDUCE ACE2 RECEPTOR EXPRESSION?: A HISTOLOGIC STUDY USING TRANSGENDER WOMEN’S TESTICLE TISSUE AFTER ORCHIECTOMY, AND, IMPLICATIONS FOR POSSIBLE USE FOR COVID19 TREATMENT AND/OR PREVENTION John M. Masterson, Chau Bui, Yi Zhang, Xiaopen Yuan, Carissa Huynh, Harneet Jawanda, Wohaib Hasan, Daniel Luthringer, Warren Tourtellotte, and Maurice Garcia John M. MastersonJohn M. Masterson More articles by this author , Chau BuiChau Bui More articles by this author , Yi ZhangYi Zhang More articles by this author , Xiaopen YuanXiaopen Yuan More articles by this author , Carissa HuynhCarissa Huynh More articles by this author , Harneet JawandaHarneet Jawanda More articles by this author , Wohaib HasanWohaib Hasan More articles by this author , Daniel LuthringerDaniel Luthringer More articles by this author , Warren TourtellotteWarren Tourtellotte More articles by this author , and Maurice GarciaMaurice Garcia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002044.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Invasion of cells by SARS-CoV-2 is mediated by the ACE2 receptor (ACE2r), which is highly expressed in testicle tissue. It has been proposed that men hospitalized with COVID19 be treated with estrogen (E) or E and Progesterone (P), however results of these trials remain unknown. Transgender women (TW) (male to female) are routinely treated with E or E+P regimens for feminization. We analyzed differences in ACE2r expression in testicles of TW taking E or E+P. METHODS: Orchiectomy specimens were collected from TW undergoing gender-affirming surgery, who were taking E or E+P preoperatively. For controls, we used benign orchiectomy specimens from cis-gender men. All specimens were stained with H&E, Trichrome (fibrosis), insulin-liken3 antibody (INS) (Leydig cell), and ACE2r IHC. Cells per high-powered field (HPF) were counted by cell type (Leydig, Sertoli, Germ). Stain intensity was rated on a 0-2 scale. IHC scoring was performed in a blinded fashion by a senior GU Pathologist. Mean cell type/HPF and stain intensity were compared across cohorts using Student’s t-test (p<0.05). Intracohort findings were stratified by age (< or >40). RESULTS: On IHC for Leydig cells and ACE2r staining the EP cohort had fewer Leydig cells compared to controls. The EP cohort also had greater degree of tissue fibrosis compared to controls and the E cohort. On intra-cohort analysis, TW >age 40 had lower Sertoli cell (H&E, ACE2r) and Germ cell (ACE2r) counts, and lower ACE2r stain intensity on Leydig cells. The EP cohort of TW >age 40 also showed increased fibrosis to TW age