Interesting data was obtained by us in assessing the state of spermatogenesis. We were able to analyze semen in 17 patients. In addition, all patients underwent a cytogenetic examination, as a result of which all had a normal karyotype – 46, XY (corresponding to the male gonad floor) without disturbing the number and structure of chromosomes. The age of the subjects – from 19 to 40 years. The rest of the patients could not analyze the spermograms due to their extremely negative attitude towards the method of obtaining ejaculate (the ejaculate was obtained by masturbation, which is the most physiological method, WHO, 1992). In 5 patients, in addition to the semiological analysis, a quantitative karyological analysis of the composition was carried out according to the stages of development of immature germ cells from the ejaculate in the laboratory of genetics of reproductive disorders of the Medical Genetic Research Center of the Russian Academy of Medical Sciences. In all cases, the ejaculate was obtained immediately before conducting laboratory studies – in a dry tube with an optimal temperature to eliminate the “cold shock” of sperm, and a different degree of decrease in motility and a decrease in the total number of spermatozoa were found (Table 2).
Thus, in 100% of cases, there is a violation of spermatogenesis in the form of oligoasthenozoospermia up to azoospermia (23.5%), which is most likely due to the state of chronic stress in which the patients are found until the completion of the treatment aimed at changing sex. In 5 patients, a quantitative karyological analysis of the composition of immature germ cells was performed, which indicates the inhibition of spermatogenesis, its partial blockade at the prophase stages of the first meiosis before pachytenas and the intensive degeneration of immature germ cells.
Ejaculate analysis was also carried out in 5 patients with homosexuality, imitating transsexualism. In this group, no deviations in the indices of spermatogenesis were identified. In the control group, ejaculate changes were also not detected. It is important to note that prior to the study, patients
received hormone treatment. To explain this phenomenon, attempts were made to associate violations of spermatogenesis with a number of possible etiological factors:
● X-ray exposure (living in an area with a high background radiation level, in a radioactively contaminated area);
● testicular tuberculosis;
● exposure to toxic substances;
● use of thermal physiocontraception;
● Cryptorchidism in history or at present;
● congenital pathology;
● chronic prostatitis;
● virus testicular damage.
The data of the survey, examination, palpation, laboratory research methods allowed to reject all the above reasons.
We propose to use, given the simplicity of the method, the analysis of the ejaculate as a differential diagnostic test in all patients with M / J-transformation.
Interestingly, for the first time, attention was paid to the violation of spermatogenesis in patients with M / W-transsexualism at the end of the 19th century, when Dr. Bernardi did not detect spermatozoa in the semen of 5 patients. However, he made the erroneous conclusion that “… solving a thousand-year-old puzzle … lies in the fact that these patients are … female freaks who have nothing in common with a man, except for the genitals, sometimes, by the way, underdeveloped … “, and further research in this area were discontinued.
Application in the examination of patients with transsexualism developed in the laboratory of genetics of reproduction disorders of the Medical Research Center of the Russian Academy of Medical Sciences the method of quantitative karyological analysis of the composition of immature germ cells from the ejaculate allowed the inhibition of spermatogenesis in patients with M / W-transsexualism, its partial blockade at the prophase 1 stage of meiosis to pachytenas and the intensive degeneration of immature germ cells.
In 5 patients with M / G-transsexualism, histological examination of the testicles removed during gonadectomy was performed. The changes in spermatogenesis that we found in spermiological analysis in these patients were reflected in the nature of changes in testicular tissue: all patients had hyalinosis of the seminiferous tubules, a decrease in the number and degeneration of Leydig cells. However, further research is needed to address the relationship between changes in testicular tissue and impaired spermatogenesis.