Anti-müllerian hormone (AMH) as the primary marker for ovarian reserve in transgender male, with or without pcos, under cronic testosterone treatment

Pardo Ines Modrego; Balaguer Marcelino Gómez; Pastor Sandra Garzón; Ariño Carlos Morillas

doi:10.1530/endoabs.70.AEP830

Background: AMH represents a marker of ovarian reserve and is used in monitoring the effects of gonadotoxic drugs. In PCOS is higher and is an indirect marker of hyperandrogenism. In transsexual man(TM), high prevalence of PCOS is described and AMH provide information about ovarian reserve after exposure to testosterone.

Objective: To assess the prevalence of PCOS in young TM previously to testosterone treatment, study the evolution of AMH levels and differentiate it response patterns according to the presence of PCOS.

Material and Methods: Retrospective cohort of TMtreated with testosterone followed between 2010–2018. Levels of AMH, Testosterone, Androstenedione, LH, FSH and Estradiol at baseline and at 6 months after intramuscular testosterone were analyzed. The AMH response was evaluated based on the presence of ovariananalytic hyperandrogenism (AH) previous to treatment (testosterone ≥ 0.7 ng/ml or androstenedione ≥ 5 ng/ml) with or without clinical PCOS (Rotterdam Criteria).

Results: Of 162 HT included, the mean age was 21 years (range 13–39). Baseline AMH 3.5 ng/ml (Interquartile range (IR) 3), Testosterone 0.4 ng/ml (IR 0.1), androstenedione 3.23 ng/ml (IR 1.89), FSH 4.3 mUI/ml (IR 3), LH 5.1 mUI/ml (IR 5) and estradiol 63 pg/ml (IR 79). 8% (n = 13) of the sample had PCOS (median age19 years (range 15–33)) and 19% (n = 31) had AH (median age 21 years (range 15–34)), without differences. A correlation was observed between baseline levels of AMH and Testosterone: 0.2 (P = 0.01) in the general group, 0.479 (P = 0.006) in AH group and 0.549 (P = 0.051) in PCOS. Table 1 shows the baseline levels of hormones in different groups. Table 2 shows the changes in AMH throughout the follow-up in different groups.

**Table 1**
Baseline hormones (ng/ml) Median (IR)	PCOS		P-value (U Mann-Whitney)	AH		P-value (U Mann-Whitney)
Baseline hormones (ng/ml) Median (IR)	Yes (n = 13)	No (n = 149)	P-value (U Mann-Whitney)	Yes (n = 31)	No (n = 131)	P-value (U Mann-Whitney)
AMH	4.5(5.4)	3.4 (2.9)	0.229	3.8(4.0)	3.4(2.9)	0.55
Testosterone	0.7(0.34)	0.3 (0.1)	<0.001	0.7(0.4)	0.3(0.1)	<0.001
Androstenedione	5.6(1.32)	3.5(1.56)	<0.001	5.3(1.95)	2.9(1.5)	<0.001

**Table 2**
	Baseline	6 months	P-value (Wilcoxon test)
General group (n = 118)	3.5(3.20)	2.8(2.50)	<0.001
PCOS (n = 8)	4.45(7.55)	4.2(3.42)	0.528
AH (n = 21)	3.6(4.20)	3(3.05)	0.029

Conclusions: The% of PCOS is not higher in TM compared to cis-women. AMH can be a good subrogated marker of PCOS and AH. The ovarian follicular reserve measured by AMH is not significantly damaged by treatment with testosterone in the short or medium term. This response is no different in TM with PCOS or AH.

Endocrine Abstracts

AEP830