The Expansion of Uterus Transplantation to Transgender Women

The document discusses the potential for uterus transplantation (UTx) in transgender (TG) women, a procedure that has been gaining interest and is expected to be performed in the near future. The authors discuss several key considerations for TG UTx, including anatomical and technical challenges, hormonal support, and ethical and societal implications. The anatomical challenges include differences in the shape of the male and female pelvis, and the need for vascular anastomosis of the graft. Hormonal considerations include whether candidates should undergo orchiectomy (removal of the testicles) before UTx and pregnancy, and the potential risks of prenatal exposure to androgens. Ethical considerations include the need for a re-evaluation of the Montreal Criteria, which currently restricts UTx to genetically female individuals, and the potential benefits of UTx for TG women, such as reducing depression and suicidality. The authors conclude that TG UTx should be performed by experienced teams and that careful preparation is essential for the success of this procedure.