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Background/Objective: The frequency of hematospermia in transgender women is unknown. This report aimed to describe the development of hematospermia in a transgender woman. Case Report: A 35-year-old transgender woman treated with estradiol valerate and leuprolide presented with painless rust-tinged ejaculate, urethral bleeding after ejaculation, and intermittent hematuria. Her medical history included gastroesophageal reflux disease, internal hemorrhoids, and attention deficit hyperactivity disorder with negative tobacco smoking and urologic history. Additional medications included emtricitabine-tenofovir disoproxil fumarate and fexofenadine. Physical examination did not reveal constitutional or genitourinary abnormalities. Urinalysis and culture disclosed rare white blood cells with gram-variable bacilli. The chlamydia, gonorrhea, and human immunodeficiency virus test results were negative. Abdominal computed tomography did not reveal bladder or prostate cancer, calcifications, inflammation, or cysts. She continued to have symptoms after this initial workup. One year after the initial symptom onset, transrectal ultrasound disclosed a 1.7-cm midline posterior prostatic cyst with hemorrhagic products, later revealed by magnetic resonance imaging as communicating with the left seminal vesicle. Two ultrasound-guided transperineal biopsy samples revealed benign prostatic tissue with a small focus of Müllerian or endometrial-type tissue, evidenced by immunopositivity for paired-box gene 8 and estrogen receptor in epithelium and cluster of differentiation 10 immunopositivity in stroma. After medical consultation, the patient underwent prostatic cyst aspiration, resection of the transurethral ejaculatory ducts, and orchiectomy. She did not experience any complications after these procedures. Discussion: The etiology of hematospermia may be idiopathic, iatrogenic, anatomic, or pathologic. Conclusion: Occult endometriosis or ectopic Müllerian epithelial tissue growth may occur in transgender women taking feminizing gender-affirming hormone therapy.

Introduction: Some providers report concern for the safety of transgender hormone therapy (HT). Methods: This is a systematic literature review of HT safety for transgender adults. Results: Current literature suggests HT is safe when followed carefully for certain risks. The greatest health concern for HT in transgender women is venous thromboembolism. HT among transgender men appears to cause polycythemia. Both groups experienced elevated fasting glucose. There is no increase in cancer prevalence or mortality due to transgender HT. Conclusion: Although current data support the safety of transgender HT with physician supervision, larger, long-term studies are needed in transgender medicine.

ABSTRACT: Objective: With the intensified public awareness and media coverage of issues concerning gender identity and gender incongruence, distinguishing true gender dysphoria or incongruence from the sexual obsessions of obsessive-compulsive disorder (OCD) is especially important. Although intrusive sexual obsessions are not uncommon in OCD, obsessions concerning sexual content are more difficult for clinicians to identify as OCD than other types of obsessions (e.g., obsessions concerning contamination). Making the correct diagnosis helps ensure that appropriate clinical treatment can be offered.Methods: We present a case report of a homosexual, single, young male with new-onset intrusive repetitive obsessive thoughts that he was transgender. The case report is accompanied by a review of the pertinent endocrine and psychiatric literature.Results: A Yale-Brown Obsessive Compulsive Scale indicated a significant negative impact of the patient's symptoms.Conclusion: To our knowledge, this is the first case report of an OCD patient whose symptoms include the unwanted, intrusive obsessive thought that he was transgender. The described case and associated review highlight the characteristics that distinguish the distress in patients with OCD who present with obsessions concerning being transgender relative to patients who are transgender or gender incongruent who present with gender dysphoria. The case illustrates the importance of considering OCD as a potential diagnosis in patients who present with new-onset obsessions regarding gender identity and the importance of establishing the durability and pattern of gender identification and obsessions before embarking on treatment.Abbreviations: DSM = Diagnostic and Statistical Manual of Mental Disorders OCD = obsessive-compulsive disorder Y-BOCS = Yale-Brown Obsessive Compulsive Scale