How do elevated levels of testosterone affect the function of the human fallopian tube and fertility?—New insights

• Published in: Molecular reproduction and development 2020-01, Vol.87 (1), p.30-44
• Main Authors: Dulohery, Kate, Trottmann, Matthias, Bour, Susanne, Liedl, Bernhard, Alba‐Alejandre, Irene, Reese, Sven, Hughes, Barbara, Stief, Christian G., Kölle, Sabine
• Format: Article
• Language: English
• Subjects: Adult; Cervix Mucus; Cilia - enzymology; Cilia - pathology; Embryogenesis; Embryonic growth stage; Fallopian tube; Fallopian Tube Diseases - chemically induced; Fallopian Tubes - drug effects; Female; Fertility; Fertility - drug effects; Fertilization; Hormone replacement therapy; human; Humans; hyperandrogenism; Hysterectomy; Male; Middle Aged; Ovariectomy; Patients; PCOS; Polycystic ovary syndrome; Polycystic Ovary Syndrome - pathology; Receptors, Androgen - metabolism; Secretions; Sexual behavior; Sexual intercourse; Spermatozoa - drug effects; Spermatozoa - pathology; Surgery; Testosterone; Testosterone - administration & dosage; Testosterone - adverse effects; Testosterone - blood; Testosterone - pharmacology; Transgender Persons; transsexual; Young Adult
• ISSN: 1040-452X; 1098-2795
• DOI: 10.1002/mrd.23291

Excess testosterone levels affect up to 20% of the female population worldwide and are a key component in the pathogenesis of polycystic ovary syndrome. However, little is known about how excess testosterone affects the function of the human fallopian tube—the site of gamete transport, fertilization, and early embryogenesis. Therefore, this study aimed to characterize alterations caused by long‐term exposure to male testosterone levels. For this purpose, the Fallopian tubes of nine female‐to‐male transsexuals, who had been undergoing testosterone treatment for 1–3 years, were compared with the tubes of 19 cycling patients. In the ampulla, testosterone treatment resulted in extensive luminal accumulations of secretions and cell debris which caused ciliary clumping and luminal blockage. Additionally, the percentage of ciliated cells in the ampulla was significantly increased. Transsexual patients, who had had sexual intercourse before surgery, showed spermatozoa trapped in mucus. Finally, in the isthmus complete luminal collapse occurred. Our results imply that fertility in women with elevated levels of testosterone is altered by tubal luminal obstruction resulting in impaired gamete transport and survival. Excess testosterone levels affect up to 20% of the female population worldwide yet little is known about how it impacts the function of the human fallopian tube. Our results show that in the ampulla, exposure to male levels of testosterone resulted in luminal blockage, while in the isthmus complete luminal collapse occurred. Our results suggest that reduced fertility in women with elevated levels of testosterone—when ovulation has occurred—may be linked to tubal luminal obstruction resulting in impaired gamete transport and survival.