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According to international guidelines, cross\u2010sex hormone therapy in trans\u2010women should lead to a psychologically and physiologically healthy body with feminized serum hormone levels, resulting in suppression of spermatogenesis. However, in a recently published multi\u2010center study, we discovered a high proportion of patients with male serum hormone levels and qualitatively intact spermatogenesis on the day of sex reassignment surgery. The objective of this study was to review the content of 11 publications that focus on the influence of cross\u2010sex hormone therapy on testicular morphology. These publications were identified based on a PubMed search for the key words transgender\/transsexual\/gender dysphoria in male\u2010to\u2010female persons, cross\u2010sex hormone therapy, and testicular tissues. Whereas three publications described a marked reduction of the spermatogenic level in all patients examined, eight publications reported inconsistent results. Histological analyses showed highly variable outcomes from qualitatively normal spermatogenesis and undisturbed Leydig\/Sertoli cell morphology to full testicular regression with severe cellular damage and hyalinization. Explanations for these heterogeneous findings include insufficient cross\u2010sex hormone therapy regarding dosage or duration. As complete spermatogenesis is associated with virilized serum hormone levels, these patients may face challenges especially after sex reassignment surgery in adjusting to the abruptly established hypogonadal state following removal of the testes. These findings also suggest that contraception should be discussed, and fertility preservation should be offered during\/prior to cross\u2010sex hormone therapy. There is a need for more individualized and better\u2010controlled cross\u2010sex hormone therapy and post\u2010treatment regimens. Evidence\u2010based guidelines for attending clinicians need to be established in order to deliver the most appropriate care.<\/jats:p>","DOI":"10.1111\/andr.12405","type":"journal-article","created":{"date-parts":[[2017,9,15]],"date-time":"2017-09-15T10:10:25Z","timestamp":1505470225000},"page":"873-880","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":95,"title":["Andrology of male\u2010to\u2010female transsexuals: influence of cross\u2010sex hormone therapy on testicular function"],"prefix":"10.1111","volume":"5","author":[{"given":"F.","family":"Schneider","sequence":"first","affiliation":[{"name":"Center of Reproductive Medicine and Andrology Institute of Reproductive and Regenerative Medicine Muenster Germany"},{"name":"Department of Clinical Andrology Center of Reproductive Medicine and Andrology Muenster 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