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Canavera KE, Bjornard KL, Cost NG, Grady A, Irving H, Kaye EC, Ketterl T, Levine J, Reinecke J, Rios J, Roth M, Sawyer K, Thomas SM, Unguru Y, Johnson LM. Disparate Access to Fertility Preservation in Youth: A Call for Advocacy to Close the Gap. J Pediatr 2023; 261:113496. [PMID: 37211206 DOI: 10.1016/j.jpeds.2023.113496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 04/07/2023] [Accepted: 05/14/2023] [Indexed: 05/23/2023]
Affiliation(s)
| | - Kari L Bjornard
- Department of Pediatrics, Division of Hematology/Oncology, Indiana University School of Medicine, Indianapolis, IN; Riley Hospital for Children at Indiana University Health, Indianapolis, IN
| | - Nicholas G Cost
- Department of Pediatric Urology and the Surgical Oncology Program, Children's Hospital Colorado, Aurora, CO
| | - Allison Grady
- Department of Pediatrics, Oncology Section, Medical College of Wisconsin, Milwaukee, WI; University of Wisconsin-Milwaukee College of Nursing, Milwaukee, WI
| | - Helen Irving
- Department of Oncology, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Erica C Kaye
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
| | - Tyler Ketterl
- Department of Pediatric Hematology/Oncology, Seattle Children's Hospital, Seattle, WA
| | - Jennifer Levine
- Division of Pediatric Hematology and Oncology, Weill Cornell Medicine, New York, NY
| | | | - Julie Rios
- Department of Obstetrics, Gynecology, and Reproductive Science, The University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Michael Roth
- Division of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kimberly Sawyer
- Department of Pediatrics, Section of Palliative Care, Baylor College of Medicine, Houston, TX
| | - Stefanie M Thomas
- Department of Pediatric Hematology, Oncology, and Bone Marrow Transplant, Cleveland Clinic Children's, Cleveland, OH
| | - Yoram Unguru
- Division of Pediatric Hematology/Oncology, The Herman and Walter Samuelson Children's Hospital at Sinai, Baltimore, MD; Johns Hopkins Berman Institute of Bioethics, Baltimore, MD
| | - Liza-Marie Johnson
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN.
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2
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Stolk THR, van den Boogaard E, Huirne JAF, van Mello NM. Fertility counseling guide for transgender and gender diverse people. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2023; 24:361-367. [PMID: 37901065 PMCID: PMC10601500 DOI: 10.1080/26895269.2023.2257062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Affiliation(s)
- T. H. R. Stolk
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Obstetrics & Gynaecology, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
| | - E. van den Boogaard
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Obstetrics & Gynaecology, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
| | - J. A. F. Huirne
- Department of Obstetrics & Gynaecology, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
| | - N. M. van Mello
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Obstetrics & Gynaecology, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
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3
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Remaud É. [Avenues for reflection on the ethical issues of support and recognition of the autonomy of transgender minors in France]. Med Sci (Paris) 2023; 39:39-43. [PMID: 36692317 DOI: 10.1051/medsci/2022196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
As the number of children and adolescents expressing transidentity has increased in recent years, a societal controversy has emerged over the appropriate therapeutic approach and medical options. The support of transgender minors raises ethical questions to which it is necessary to provide avenues for reflection, in particular on the issues of recognizing the autonomy of these young people in the consent and decisionmaking processes.
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Affiliation(s)
- Émilie Remaud
- Département de philosophie, UFR Lettres et langages, Nantes université, Nantes, France - Faculté de médecine, Sorbonne Université, Paris, France
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Durcan E, Turan S, Bircan BE, Yaylamaz S, Okur I, Demir AN, Sulu C, Kara Z, Sahin S, Taze SS, Mefkure Ozkaya H, Kadioglu P. Fertility Desire and Motivation Among Individuals with Gender Dysphoria: A Comparative Study. JOURNAL OF SEX & MARITAL THERAPY 2022; 48:789-803. [PMID: 35332854 DOI: 10.1080/0092623x.2022.2053617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Despite receiving Gender-Affirming Hormone Therapy or Gender-Affirming Surgery, which may adversely impact their fertility, people with Gender Dysphoria (GD) may desire to form families. In this study, we aimed to quantitatively display fertility desire from the perspective of these individuals, despite all the legal challenges they face. The single center, cross-sectional comparative study included individuals with GD and cisgender volunteers. A Sociodemographic Data Form, the Fertility Desire Data Form, the Childbearing Motivations Scale and the Fertility Desire Scale were used. Of the 414 participants, 171 were individuals with GD (110 FtM; 61 MtF) and 243 were cisgender volunteers (142 cis-males; 101 cis-females). While 22% of the people with GD stated that they had regrets about not undergoing fertility preservation, 16% stated that they would like this process if it were legal. People with GD, particularly MtF, want to have children more than cisgenders. Moreover, people with MtF exhibited less negative motivations toward becoming parents, despite having reservations regarding the socioeconomic aspect of parenthood. Our findings indicate that fertility desire in people with GD is not less in comparison to cisgender people. Healthcare professionals should not forget to offer fertility preservation options as part of clinical practice before Gender-Affirming Therapy.
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Affiliation(s)
- Emre Durcan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Senol Turan
- Department of Psychiatry, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Basak Ecem Bircan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Selver Yaylamaz
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ihsan Okur
- Department of Psychiatry, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ahmet Numan Demir
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Cem Sulu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Zehra Kara
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Serdar Sahin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Sabriye Sibel Taze
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Hande Mefkure Ozkaya
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Pinar Kadioglu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Krebs D, Harris RM, Steinbaum A, Pilcher S, Guss C, Kremen J, Roberts SA, Baskaran C, Carswell J, Millington K. Care for Transgender Young People. Horm Res Paediatr 2022; 95:405-414. [PMID: 35272283 PMCID: PMC9463393 DOI: 10.1159/000524030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 03/08/2022] [Indexed: 11/19/2022] Open
Abstract
Clinicians of all disciplines, including pediatric endocrinologists, are likely to encounter transgender and gender-diverse (TGD) young people in their practice regardless of whether they specialize in gender-affirming medical care. Because of this, it is important to be aware of the ways in which medical professionals can affirm these individuals. Although gender-affirming therapy should always include affirmation including proper use of names and pronouns, the transition journey will look different for each patient. The gender-affirming care of TGD young people may include both medical and nonmedical interventions (e.g., social transition). Therapies utilized for medical gender transition such as gonadotropin-releasing hormone agonists and/or gender-affirming hormones have implications for growth, bone health, cardiovascular health, and fertility, although these impacts are not yet completely understood. This review provides an overview of the care of transgender young people as well as a summary of what is known about the outcomes of these therapies. Clinicians should advise TGD young people and their families of the known and unknown risks and work together with patients to decide upon a treatment and follow-up regimen that aligns with their individual gender affirmation and health goals.
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Affiliation(s)
- Damian Krebs
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Rebecca M Harris
- Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Sarah Pilcher
- Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Carly Guss
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.,Division of Adolescent Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jessica Kremen
- Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Stephanie A Roberts
- Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Charumathi Baskaran
- Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Jeremi Carswell
- Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Kate Millington
- Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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Barrett F, Shaw J, Blakemore JK, Fino ME. Fertility Preservation for Adolescent and Young Adult Transmen: A Case Series and Insights on Oocyte Cryopreservation. Front Endocrinol (Lausanne) 2022; 13:873508. [PMID: 35685214 PMCID: PMC9171925 DOI: 10.3389/fendo.2022.873508] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/07/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The opportunity for fertility preservation in adolescent and young adult (AYA) transmen is growing. Many AYA transmen desire future biologic children and are interested in ways to preserve fertility through oocyte cryopreservation prior to full gender affirmation, yet utilization of oocyte cryopreservation remains low. Additionally, standard practice guidelines currently do not exist for the provision of oocyte cryopreservation to AYA transmen. Our objective was to review our experience with oocyte cryopreservation in adolescent and young adult transmen in order to synthesize lessons regarding referral patterns, utilization, and oocyte cryopreservation outcomes as well as best practices to establish treatment guidance. METHODS This is a case series of all AYA transmen (aged 10 to 25 years) who contacted, consulted or underwent oocyte cryopreservation at a single high volume New York City based academic fertility center between 2009 and 2021. RESULTS Forty-four adolescent and young adult transmen made contact to the fertility center over the study period. Eighty percent (35/44) had a consultation with a Reproductive and Endocrinology specialist, with a median age of 16 years (range 10 to 24 years) at consultation. The majority were testosterone-naive (71%, 25/35), and had not pursued gender affirming surgery (86%, 30/35). Expedited initiation of testosterone remained the most commonly cited goal (86%, 30/35). Fifty-seven percent (20/35) pursued oocyte cryopreservation. Ninety-five percent (19/20) underwent successful transvaginal oocyte aspiration, with a median of 22 oocytes retrieved and 15 mature oocytes cryopreserved. There were no significant adverse events. At time of review, no patient has returned to utilize their cryopreserved oocytes. CONCLUSIONS Oocyte cryopreservation is a safe fertility preservation option in AYA transmen and is an important aspect of providing comprehensive transgender care. Insights from referral patterns, utilization, and oocyte cryopreservation outcomes from a single center's experience with adolescent and young adult transmen can be integrated to identify lessons learned with the goal of providing transparency surrounding the oocyte cryopreservation process, improving the education and comfort of patients and providers with fertility preservation, and easing the decision to pursue an oocyte cryopreservation cycle in parallel to gender-affirmatory care.
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Affiliation(s)
- Francesca Barrett
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, NY, United States
| | - Jacquelyn Shaw
- Department of Reproductive Endocrinology and Infertility, New York University Langone Fertility Center, New York, NY, United States
| | - Jennifer K. Blakemore
- Department of Reproductive Endocrinology and Infertility, New York University Langone Fertility Center, New York, NY, United States
| | - Mary Elizabeth Fino
- Department of Reproductive Endocrinology and Infertility, New York University Langone Fertility Center, New York, NY, United States
- *Correspondence: Mary Elizabeth Fino,
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Vrouenraets LJ, de Vries MC, Hein IM, Arnoldussen M, Hannema SE, de Vries AL. Perceptions on the function of puberty suppression of transgender adolescents who continued or discontinued treatment, their parents, and clinicians. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2021; 23:428-441. [PMID: 36324881 PMCID: PMC9621271 DOI: 10.1080/26895269.2021.1974324] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Purpose: Treatment of transgender adolescents with puberty suppression (PS) was developed to provide time for exploration before pursuing gender affirming medical treatment (GAMT) with irreversible effects. It may also result in a more satisfactory physical outcome for those who continue with GAMT. Despite being the current first choice treatment, little research has examined the function of PS from the perspectives of transgender adolescents, their parents, and clinicians. Insight into the perceived functions of PS will help to adequately support adolescents in their decision-making process and give them the care they need. Methods: Qualitative study using interviews with eight transgender adolescents who proceeded with GAMT after PS ("continuers"), six adolescents who discontinued PS ("discontinuers") and 12 parents, and focus groups with ten clinicians. Results: All informants considered inhibition of development of secondary sex characteristics an important function of PS. Most continuers saw PS as the first step of GAMT. Nevertheless, some were glad that the effects were reversible even if they didn't expect to change their minds. Some discontinuers did experience PS as an expanded diagnostic phase. One continuer used the time on PS to get used to living in the affirmed gender role, and several parents found the time helpful to adapt to their child's new gender role. PS provided clinicians more time for diagnostic assessment. Conclusions: Adolescents, parents and clinicians do not all report the same functions of PS. Although international guidelines emphasize providing time for exploration of gender identity as an important reason for PS, many adolescents nowadays seem to have clear ideas about their gender identity and treatment wishes, and experience PS as the first step of GAMT. For some discontinuers however, PS offered a valued period of exploration. Guidelines could be modified to provide more customized care, taking adolescents' and parents' ideas about the functions of PS into account.
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Affiliation(s)
- Lieke J.J.J. Vrouenraets
- LUMC Curium-Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Oegstgeest, The Netherlands
- Department of Medical Ethics and Health Law, Leiden University Medical Center, Leiden, The Netherlands
| | - Martine C. de Vries
- Department of Medical Ethics and Health Law, Leiden University Medical Center, Leiden, The Netherlands
| | - Irma M. Hein
- Department of Child and Adolescent Psychiatry, Amsterdam University Medical Centers, Location AMC, University of Amsterdam and Levvel, Amsterdam, The Netherlands
| | - Marijn Arnoldussen
- Department of Child and Adolescent Psychiatry, Amsterdam University Medical Centers, Location VUmc, VU Universiteit, Amsterdam, The Netherlands
| | - Sabine E. Hannema
- Department of Paediatric Endocrinology, Amsterdam University Medical Centers, Location VUmc, VU Universiteit, Amsterdam, the Netherlands
- Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Annelou L.C. de Vries
- Department of Child and Adolescent Psychiatry, Amsterdam University Medical Centers, Location VUmc, VU Universiteit, Amsterdam, The Netherlands
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