ESPE Yearbook of Paediatric Endocrinology

To read the full abstract: J Adolesc Health. 2020, Apr 29; 10.1016/j.jadohealth.2020.02.027. doi: 10.1016/j.jadohealth.2020.02.027, PMID 32359942. https://www.ncbi.nlm.nih.gov/pubmed/32359942

Fertility preservation among transgender youth undergoing gender-affirming hormone treatment is a topic of increasing interest. This study describes the attitudes of youth and parents towards fertility and fertility preservation. Surveys in youths and their parents investigated the desire for biological children in the future and the willingness to delay gender-affirming hormone treatment in order to have fertility preserving therapy first. This is a cross-sectional study of 64 youths and 46 parents in Pennsylvania, USA. The mean age was 16.8 years (12–24 years), and 68% were assigned female at birth. Only 20% of youths and 13% of parents thought it was important to have biological children/grandchildren, and only 27–30% were willing to undergo procedures to preserve fertility. The factors influencing this decision were: discomfort with the body (in 69% of youth), delaying hormonal treatment (50%), and financial aspects (47%). Similarly, in another study of 79 youth, having children was the least important priority (1).

This is an important and difficult topic. Only a minority considered it important to have biological children in the future. On the other hand, priorities in life change over time for many people, and having children often becomes more important beyond adolescence. In addition, there was a large difference in attitudes to fertility preservation between transgender females and males: 60% of adolescent transgender females had sperm preservation, while none of the transgender males underwent oocyte preservation (2). For irreversible treatments, especially for treatments that affect fertility, it is important that the individual is old enough to understand the consequences of such a decision. It remains a question whether this is always the case. Further studies should investigate attitudes towards fertility issues later in life and possibilities for fertility treatment after initiation of gender-affirming hormone treatment (3).

References :

1. Perspectives on fertility preservation and parenthood among transgender youth and their parents. Chiniara LN, Viner C, Palmert M, Bonifacio H. Arch Dis Child. 2019, Aug; 104: 739–44; DOI 10.1136/archdischild-2018-316080, PMID 30894340. https://adc.bmj.com/content/archdischild/104/8/739.full.pdf

2. Rates of Fertility Preservation Use Among Transgender Adolescents. Pang KC, Peri AJS, Chung HE, Telfer M, Elder CV, Grover S, Jayasinghe Y. JAMA Pediatr. 2020, Apr 13; 10.1001/jamapediatrics.2020.0264; DOI 10.1001/jamapediatrics. 2020.0264, PMID 32282014. https://jamanetwork.com/journals/jamapediatrics/articlepdf/2764075/jamapediatrics_pang_2020_ld_200006.pdf

3. Assisted reproductive technology outcomes in female-to-male transgender patients compared with cisgender patients: a new frontier in reproductive medicine. Leung A, Sakkas D, Pang S, Thornton K, Resetkova N. Fertil Steril. 2019, Nov; 112: 858–65; DOI 10.1016/j.fertnstert.2019.07.014, PMID 1594633. https://www.ncbi.nlm. nih.gov/pubmed/31594633