ESPE Yearbook of Paediatric Endocrinology

Pediatrics. 2018 Sep;142(3). pii: e20173142.

doi: 10.1542/peds.2017-3142. PMID:30072573

While awaiting a breakthrough in research on in vitro maturation of immature gametes, the best option for transgender youth to secure fertility is to cryopreserve mature sperm, oocytes or gonadal tissue. This often requires postponement or arrest of transitional hormone medication, and this may be one of the main reasons why many trans adolescents do not choose this option. This decision may lead to conflict with their parents, who often wish to keep all options open. For healthcare workers involved in adolescent transgender teams, it is not always clear how to deal with such disagreement.

This article provides guidance for clinicians who are faced with such difficult situations. The format is a reflection of four specialists in the field who balance the arguments and expectations of adolescents against parental wishes, scientific knowledge, and ethical and legal constraints. It is argued that although currently only very few adolescents choose to undergo fertility preserving measures, this should by no means be a reason to limit counseling on this topic. Indeed, transgender adults often have a strong interest in having biological children. Thus, it is crucial for transgender teams and parents to find out how to talk about a topic that is not important now but may become so in the future.

Ultimately, there is a broad consensus that the adolescent, who has been found mature enough to decide on his/her gender, and after having been informed extensively on all options and their consequences, has the final say in this discussion.