The Emerging Concept of Hormonal Impact on Wound Healing in Feminizing and Masculinizing Genital Surgery
We attempt, within this review, to discuss the effects of hormones for their known impact on the wound healing cascade. Hormone receptors mediate a cellular response; changes in their expression, whether physiologic or pathologic, affect growth and development, and have effects on wound healing. Attempts to measure their distribution have been quite variable in their effectiveness not only between but within a given tissue. Other factors contribute to this variability. These include age, gender, and tissue histology (urinary mucosae, periurethral vessels, muscular layer, and connective tissue). Gene expression and autonomic nervous system receptors have been noted to change in relation to variance in hormonal status. Reduced levels of estrogens and androgen are associated with dramatic alterations in genital tissue structure, including the nerve network, as well as the response to physiological modulators. Estrogen and androgen deficiency is associated with reduced expression of sex steroid receptors. Cutaneous, vascular, and mucosal tissue of the genitalia, may be more sensitive than other tissues to the effects of a variety of hormones with differential effects for mucosal versus cutaneous epithelium, and for male and female derived tissue. We might also imagine that chromosomal variations exhibited in disorders of sexual development could modify the hormonal environment and the response to hormones during wound healing.