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Salhah H, Bonny A, Benedict J, Nahata L. Fertility Perspectives and Concerns in Adolescents With PCOS Compared to Controls. J Adolesc Health 2024:S1054-139X(24)00305-7. [PMID: 39140925 DOI: 10.1016/j.jadohealth.2024.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 05/28/2024] [Accepted: 06/21/2024] [Indexed: 08/15/2024]
Abstract
PURPOSE Polycystic ovary syndrome (PCOS) is prevalent in young females and is known to affect fertility. Minimal research has examined fertility perspectives in adolescents with PCOS, despite adult research revealing relationships between infertility and psychosocial well-being and quality of life. We examined fertility perspectives/concerns in adolescents with PCOS and an age- and body mass index (BMI)-matched control group and explored associations with quality of life. METHODS This was a cross-sectional study of female adolescents (13-21 years of age) with PCOS (n = 50) and age- and BMI-matched controls (n = 50), recruited at a large Midwestern pediatric center. Surveys assessed sociodemographics, hirsutism, fertility perspectives and quality of life. Descriptive statistics and Welch's 2-sample t-tests were used to examine fertility perspectives and quality of life. RESULTS Of the 103 approached, 100 participants were enrolled (97% recruitment rate), with 50 participants in each group. Parenthood goals did not significantly differ between groups; >70% expressed desire to have biological children. However, PCOS participants reported significantly higher concerns about future fertility (p < .01) without differences in fertility knowledge or support (p = .53). Most PCOS participants stated they would feel angry if their provider withheld this information and reported wanting more information. Quality of life did not differ between groups. DISCUSSION Our study suggests that irrespective of PCOS status, most adolescents aspire to parenthood. Notably, many with PCOS lack awareness of infertility risks but express heightened concerns. In contrast to adult studies, fertility concerns among adolescents with PCOS were not associated with decreased quality of life, suggesting that earlier fertility counseling may improve outcomes.
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Affiliation(s)
- Hiba Salhah
- Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
| | - Andrea Bonny
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio; The Ohio State University College of Medicine, Columbus, Ohio
| | | | - Leena Nahata
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio; The Ohio State University College of Medicine, Columbus, Ohio.
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Stanley JR, Ratnapalan S. Patient education and counselling of fertility preservation for transgender and gender diverse people: A scoping review. Paediatr Child Health 2024; 29:231-237. [PMID: 39045475 PMCID: PMC11261822 DOI: 10.1093/pch/pxad050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 06/17/2023] [Indexed: 07/25/2024] Open
Abstract
Objectives To examine patient education, counselling practices, decision aids, and education resources related to fertility preservation for transgender and gender diverse (TGD) youth and young adults. Methods A scoping review was conducted using a comprehensive literature search (Ovid MEDLINE, PubMed Medline, OVID Embase, Ovid PsychoINFO, and Cochrane Central Register of Controlled Trials) conducted from 1806 to October 21, 2022. Inclusion criteria involved abstracts and articles on patient education, counselling, decision aids or education resources regarding fertility preservation for TGD youth and adults. Results Of 1,228 identified articles and abstracts, only six articles met inclusion criteria. Three key themes were identified: (1) patient education and counselling practices (n = 4), with majority of patients receiving fertility preservation counselling at their respective centres; (2) decision aids and strategies for clinicians on fertility preservation for TGD individuals (n = 2) and; (3) patient education resources (n = 1). There was a paucity of literature on decision aids and patient education resources. Conclusions This study highlights the need to further develop and evaluate decision aids for healthcare providers and patient education resources, including eLearning modules, around fertility preservation for TGD individuals.
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Affiliation(s)
- Joshua R Stanley
- Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Savithiri Ratnapalan
- Divisions of Pediatric Emergency Medicine and Clinical Pharmacology and Toxicology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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3
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Conard R, Folsom L. Family planning preferences in transgender youth in an urban multi-disciplinary gender clinic. J Clin Transl Endocrinol 2024; 36:100353. [PMID: 38828403 PMCID: PMC11143893 DOI: 10.1016/j.jcte.2024.100353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 05/12/2024] [Accepted: 05/16/2024] [Indexed: 06/05/2024] Open
Abstract
Background Known barriers to family planning in the transgender population include low utilization of cryopreservation and decisional regret. There is growing data on the risk of infertility with GAHT, and on to what degree transgender adolescents feel informed about fertility and family planning options. Objective Assess preferences regarding options for family planning and fertility preservation in transgender adolescents treated with GAHT in a pediatric endocrinology gender clinic. The goal is to enhance patient education about potential effects of GAHT on fertility and options for family planning. Methods Forty one adolescents aged 10 years and older treated with GAHT in an urban outpatient pediatric endocrinology clinic were surveyed over a 6-month period from January to June 2022. Survey questions were multiple choice, Likert scale, and open-ended. Participants were at least 10 years of age, actively followed in the clinic, and receiving GAHT at time of enrollment. Results Forty one participants completed the survey. Four (10 %) expressed interest in discussing family planning with their provider. Eighteen (45 %) were open to discussion in the future; 16 (39 %) were not interested at all. 12 (30 %) participants were planning for future parenthood, and 16 (40 %) participants were undecided. Of those interested in parenthood 7 (53.8 %) planned to adopt or foster. Barriers to family planning expressed included financial concerns, potential need to pause GAHT, and social stigma of transgender parenthood. Twenty (50 %) participants recalled prior family planning discussion with their endocrinologist. Conclusion Family planning discussions may not be optimally impactful given that 50 % of participants did not recall the conversations. Family planning is a lower priority in this population as most desired to postpone discussion with their provider despite choosing treatment that could influence fertility. It is essential to identify methods to engage transgender youth in discussions related to family planning during GAHT.
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Affiliation(s)
- Ryan Conard
- University of Louisville, School of Medicine Department of Pediatrics, affiliated with Norton Children’s Medical Group, 571 S. Floyd Street, Ste. 432, Louisville, KY 40202, USA
| | - Lisal Folsom
- University of Louisville School of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, 571 S. Floyd Street, Ste. 128, Louisville, KY 40202, USA
- Norton Children’s Medical Group – Pediatric Endocrinology, 411 E. Chestnut St.. 7 Floor, Louisville, KY 40202, USA
- Norton Healthcare – Endocrinology, 210 E. Gray St, Ste 605, Louisville, KY 40202, USA
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Chen D, Shen E, Kolbuck VD, Sajwani A, Finlayson C, Gordon EJ. Co-design and usability of an interactive web-based fertility decision aid for transgender youth and young adults. J Pediatr Psychol 2024:jsae032. [PMID: 38722239 DOI: 10.1093/jpepsy/jsae032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 03/26/2024] [Accepted: 04/16/2024] [Indexed: 05/22/2024] Open
Abstract
OBJECTIVE To develop a patient- and family-centered Aid For Fertility-Related Medical Decisions (AFFRMED) interactive website targeted for transgender and nonbinary (TNB) youth/young adults and their parents to facilitate shared decision-making about fertility preservation interventions through user-centered participatory design. METHOD TNB youth/young adults interested in or currently receiving pubertal suppression or gender-affirming hormone treatment and parents of eligible TNB youth/young adults were recruited to participate in a series of iterative human-centered co-design sessions to develop an initial AFFRMED prototype. Subsequently, TNB youth/young adults and parents of TNB youth/young adults were recruited for usability testing interviews, involving measures of usability (i.e., After Scenario Questionnaire, Net Promotor Score, System Usability Scale). RESULTS Twenty-seven participants completed 18 iterative co-design sessions and provided feedback on 10 versions of AFFRMED (16 TNB youth/young adults and 11 parents). Nine TNB youth/young adults and six parents completed individual usability testing interviews. Overall, participants rated AFFRMED highly on measures of acceptability, appropriateness, usability, and satisfaction. However, scores varied by treatment cohort, with TNB youth interested in or currently receiving pubertal suppression treatment reporting the lowest usability scores. CONCLUSIONS We co-created a youth- and family-centered fertility decision aid prototype that provides education and decision support in an online, interactive format. Future directions include testing the efficacy of the decision aid in improving fertility and fertility preservation knowledge, decisional self-efficacy, and decision satisfaction.
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Affiliation(s)
- Diane Chen
- Potocsnak Family Division of Adolescent and Young Adult Medicine, Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Elaine Shen
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Victoria D Kolbuck
- Potocsnak Family Division of Adolescent and Young Adult Medicine, Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Afiya Sajwani
- Potocsnak Family Division of Adolescent and Young Adult Medicine, Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Courtney Finlayson
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
- Division of Endocrinology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Elisa J Gordon
- Department of Surgery and Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN, United States
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Mittertreiner EJ, Ng-Cordell E, McVey AJ, Kerns CM. Research methods at the intersection of gender diversity and autism: A scoping review. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613241245595. [PMID: 38661070 DOI: 10.1177/13623613241245595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
LAY ABSTRACT Research has increasingly focused on the intersection between gender diversity and autism. To better understand this literature, this scoping review systematically searched five databases for peer-reviewed literature on gender diversity and autism published between 2018 and 2023. Included studies (N = 84) were of English language, featured original qualitative or quantitative findings, and examined a psychosocial connection between autism and gender spectra variables. Most studies focused on measuring prevalence of autism among gender-diverse individuals. While the overall study rigor was acceptable, weaknesses in measurement, sample selection, and definition of key terms were noted. Promisingly, studies in this area appear to be shifting away from a pathologizing lens and towards research methods that engage in meaningful collaboration with the autistic, gender-diverse community to investigate how to best enhance the quality of life and wellbeing of this population.
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Affiliation(s)
| | | | - Alana J McVey
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
- Autism Center, Seattle Children's Hospital, Seattle, WA, United States
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Boogers LS, Wiepjes CM, Staphorsius AS, Klink DT, Ciancia S, Romani A, Stolk THR, van den Boogaard E, Steensma TD, de Vries ALC, van Trotsenburg ASP, den Heijer M, Fisher AD, Cools M, Hannema SE. A European Network for the Investigation of Gender Incongruence in adolescents. J Sex Med 2024; 21:350-356. [PMID: 38427555 DOI: 10.1093/jsxmed/qdae014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/27/2023] [Accepted: 01/03/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Knowledge regarding the effects and side effects of gender-affirming hormone therapy (GAHT) in adults is rapidly growing, partly through international research networks such as the European Network for the Investigation of Gender Incongruence (ENIGI). However, data on the effects of puberty suppression (PS) and GAHT in transgender and gender diverse (TGD) youth are limited, although these data are of crucial importance, given the controversies surrounding this treatment. AIM We sought to present a detailed overview of the design of the ENIGI Adolescents study protocol, including the first baseline data. METHODS The ENIGI Adolescents study is an ongoing multicenter prospective cohort study. This study protocol was developed by 3 European centers that provide endocrine care for TGD adolescents and were already part of the ENIGI collaboration: Amsterdam, Ghent, and Florence. OUTCOMES Study outcomes include physical effects and side effects, laboratory parameters, bone mineral density, anthropometric characteristics, attitudes toward fertility and fertility preservation, and psychological well-being, which are measured in the study participants during PS and GAHT, up to 3 years after the start of GAHT. RESULTS Between November 2021 and May 2023, 172 TGD adolescents were included in the ENIGI Adolescents protocol, of whom 51 were assigned male at birth (AMAB) and 121 were assigned female at birth (AFAB); 3 AFAB participants reported a nonbinary gender identification. A total of 76 participants were included at the start of PS, at a median (IQR) age of 13.7 (12.9-16.5) years in AMAB and 13.5 (12.4-16.1) years in AFAB individuals. The remaining 96 participants were included at start of GAHT, at a median (IQR) age of 15.9 (15.1-17.4) years in AFAB and 16.0 (15.1-16.8) years in AMAB individuals. At the time of this report the study was open for inclusion and follow-up measurements were ongoing. CLINICAL IMPLICATIONS In response to the rising demand for gender-affirming treatment among TGD youth, this ongoing study is fulfilling the need for prospective data on the effects and safety of PS and GAHT, thus providing a foundation for evidence-based healthcare decisions. STRENGTHS AND LIMITATIONS This study has a strong multicenter, prospective design that allows for systematic data collection. The use of clinical and self-reported data offers a broad range of outcomes to evaluate. Nevertheless, the burden of additional measurements and questionnaires may lead to withdrawal or lower response rates. Few participants with a non-binary gender identity have been included. CONCLUSION With the ENIGI Adolescents study we aim to create a comprehensive dataset that we can use for a wide range of studies to address current controversies and uncertainties and to improve healthcare for TGD adolescents.
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Affiliation(s)
- Lidewij S Boogers
- Department of Endocrinology, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, 1081 HV, Amsterdam, The Netherlands
- Department of Pediatric Endocrinology, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, 1081 HZ, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, 1081 HZ, Amsterdam, The Netherlands
| | - Chantal M Wiepjes
- Department of Endocrinology, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, 1081 HV, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, 1081 HZ, Amsterdam, The Netherlands
| | - Annemieke S Staphorsius
- Department of Endocrinology, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, 1081 HV, Amsterdam, The Netherlands
| | - Daniel T Klink
- Division of Pediatric Endocrinology, Department of Pediatrics, Ghent University Hospital, 9000, Ghent, Belgium
| | - Silvia Ciancia
- Department of Internal Medicine and Pediatrics, Ghent University, 9000, Ghent, Belgium
| | - Alessia Romani
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi University Hospital, 50139, Florence, Italy
| | - Tessa H R Stolk
- Department of Obstetrics & Gynaecology, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, 1081 HV, Amsterdam, The Netherlands
| | - Emmy van den Boogaard
- Department of Obstetrics & Gynaecology, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, 1081 HV, Amsterdam, The Netherlands
| | - Thomas D Steensma
- Department of Medical Psychology, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, 1081 HV, Amsterdam, The Netherlands
| | - Annelou L C de Vries
- Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, 1081 HV, Amsterdam, The Netherlands
| | - A S Paul van Trotsenburg
- Department of Pediatric Endocrinology, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, 1081 HZ, Amsterdam, The Netherlands
| | - Martin den Heijer
- Department of Endocrinology, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, 1081 HV, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, 1081 HZ, Amsterdam, The Netherlands
| | - Alessandra D Fisher
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi University Hospital, 50139, Florence, Italy
| | - Martine Cools
- Division of Pediatric Endocrinology, Department of Pediatrics, Ghent University Hospital, 9000, Ghent, Belgium
- Department of Internal Medicine and Pediatrics, Ghent University, 9000, Ghent, Belgium
| | - Sabine E Hannema
- Department of Pediatric Endocrinology, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, 1081 HZ, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, 1081 HZ, Amsterdam, The Netherlands
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Johnson A, McClurg AB, Baldino J, Das R, Carey ET. Fertility preservation choices and decisional regret after gender-affirming surgery in transgender men or gender nonbinary persons. F S Rep 2024; 5:87-94. [PMID: 38524213 PMCID: PMC10958706 DOI: 10.1016/j.xfre.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/06/2023] [Accepted: 12/12/2023] [Indexed: 03/26/2024] Open
Abstract
Objective To investigate the prevalence of decisional regret regarding preoperative fertility preservation choices after gender-affirming surgery or removal of reproductive organs. Design Cross-sectional. Setting University-based pratice. Patients A total of 57 survey respondents identifying as transgender men or gender nonbinary with a history of gender-affirming surgery or removal of reproductive organs between 2014 and 2023 with the University of North Carolina Minimally Invasive Gynecology division. Intervention Survey or questionnaire. Main Outcome Measures The prevalence and severity of decisional regret regarding preoperative fertility preservation choices were measured with the use of the validated decisional regret scale (DRS) (scored 0-100). Secondary outcomes included patient-reported barriers to pursuing reproductive endocrinology and infertility consultation and fertility preservation treatment. Results The survey response rate was 50.9% (57/112). "Mild" to "severe" decisional regret was reported by 38.6% (n = 22) of survey respondents, with DRS scores among all respondents ranging from 0-85. Higher median DRS scores were associated with patient-reported inadequacy of preoperative fertility counseling regarding implications of surgery on future fertility or family-building (0 vs. 50) and fertility preservation options (0 vs. 12.5). No desire for future fertility at the time of fertility counseling was the most frequent reason (68.4%) for declining a referral to reproductive endocrinology and infertility for additional fertility preservation discussion. Conclusions Decisional regret regarding preoperative fertility preservation choices is experienced among transgender men or gender nonbinary persons after gender-affirming surgery or the removal of reproductive organs. Preoperative, patient-centered fertility counseling and fertility preservation treatments should be provided to reduce the risk of future regret.
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Affiliation(s)
- Austin Johnson
- Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington
| | - Asha B. McClurg
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Janine Baldino
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Rajeshree Das
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Erin T. Carey
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Komorowski AS, Fisher AR, Jungheim ES, Lewis CS, Omurtag KR. Fertility preservation discussions, referral and follow-up in male-to-female and female-to-male adolescent transgender patients. HUM FERTIL 2023; 26:903-907. [PMID: 34915792 DOI: 10.1080/14647273.2021.2015804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 09/26/2021] [Indexed: 10/19/2022]
Abstract
The number of patients seeking transgender healthcare is growing, and there is a potential impact of gender-affirming therapies on fertility. The use of fertility preservation (FP), particularly among transgender adolescents, has been limited. We aimed to examine differences in FP counselling, referral and utilisation between male-to-female (MtF) and female-to-male (FtM) transgender adolescents. A retrospective review of the medical records of patients ages 12-17 seen at an academic medical centre between 2012 and 2017 with a diagnosis of gender dysphoria was conducted. A total of 22 MtF and 45 FtM adolescents were included. The counselling on the potential fertility impact of gender-affirming therapy was documented in 55%, and of those counselled, 73% were counselled before receiving medication. There was no significant difference between the timing of counselling for MtF versus FtM adolescents. Of patients with documented reproductive wishes, 77% reported either desire for adopted children or no desire for biological children. Among patients offered FP referral, 2 (22.2%) MtF and 3 (12.5%) FtM patients accepted; both MtF patients cryopreserved sperm. While most adolescents were counselled on the fertility impact of gender-affirming therapy, there is room for improvement as 45% of patients had no documented counselling. The rate of transgender adolescents pursuing FP consultation and gamete cryopreservation was low, consistent with prior studies in this population.
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Affiliation(s)
- Allison S Komorowski
- Department of Obstetrics & Gynecology, Washington University School of Medicine, St. Louis, USA
| | - Andrew R Fisher
- Department of Obstetrics & Gynecology, The University of Chicago Medicine, Chicago, USA
| | - Emily S Jungheim
- Department of Obstetrics & Gynecology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Christopher S Lewis
- Division of Pediatric Endocrinology & Metabolism, Washington University School of Medicine, St. Louis, USA
| | - Kenan R Omurtag
- Department of Obstetrics & Gynecology, Washington University School of Medicine, St. Louis, USA
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Robinson IS, Carswell JM, Boskey E, Agarwal CA, Brassard P, Bélanger M, Zhao LC, Bluebond-Langner R. Gender-Affirming Surgery in Adolescents and Young Adults: A Review of Ethical and Surgical Considerations. Plast Reconstr Surg 2023; 152:737e-750e. [PMID: 36827481 DOI: 10.1097/prs.0000000000010325] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
BACKGROUND The number of transgender adolescents seeking gender-affirming surgery (GAS) in increasing. Surgical care of the adolescent transgender patient is associated with several unique technical, legal, and ethical factors. The authors present a review of the current literature on gender-affirming surgery for individuals under the age of legal majority and propose directions for future research. METHODS A scoping review of recent literature was performed to assess evidence on gender-affirming surgery in individuals under the age of legal majority. Articles were included that examined either ethical or technical factors unique to pediatric GAS. Study characteristics and conclusions were analyzed in conjunction with expert opinion. RESULTS Twelve articles were identified that met inclusion criteria. Ten of these articles discussed ethical challenges in adolescent GAS, seven discussed legal challenges, and five discussed technical challenges. Ethical discussions focused on the principles of beneficence, nonmaleficence, and autonomy. Legal discussions centered on informed consent and insurance coverage. Technical discussions focused on the effects of puberty blockade on natal tissue. CONCLUSIONS Surgical care of the adolescent transgender patient involves important ethical, legal, and technical considerations that must be addressed by the clinical team. As the population of individuals seeking GAS after puberty blockade increases, future research is needed describing functional and psychosocial outcomes in these individuals.
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Affiliation(s)
| | | | - Elizabeth Boskey
- Department of Plastic and Oral Surgery, Boston Children's Hospital
| | | | - Pierre Brassard
- Chirurgie Plastique et Esthétique, Centre Métropolitain de Chirurgie
| | - Maud Bélanger
- Chirurgie Plastique et Esthétique, Centre Métropolitain de Chirurgie
| | - Lee C Zhao
- Department of Urology, New York University Langone Health
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10
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Halloran J, Smidt AM, Morrison A, Cron J, Kallen AN, Olezeski CL. Reproductive and Fertility Knowledge and Attitudes Among Transgender and Gender-Expansive Youth: A Replication and Extension. Transgend Health 2023; 8:328-336. [PMID: 37525841 PMCID: PMC10387155 DOI: 10.1089/trgh.2021.0080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose This study sought to replicate and expand a previous pilot investigation of reproductive knowledge, attitudes toward fertility and parenthood, and sources of information on these topics among transgender and gender-expansive (TGE) youth. Methods The Yale Pediatric Gender Program (YPGP) Reproductive Knowledge and Experiences Survey (YPGP-RKES) was administered to 70 TGE adolescents receiving care at an interdisciplinary clinic providing gender-affirming health care at an academic medical center. Data gathered included sources of information on reproduction and fertility, concerns about future parenthood and reproduction, and interest in different types of parenthood. Results Over a third (39.1%) of participants reported it was important to them to have a child one day, while only a small proportion (23.2%) reported an interest in biological parenthood. A plurality of participants (37.3%) reported at least one concern about future fertility. The number of reproductive concerns did not differ by age or treatment (puberty blockers or gender-affirming hormones vs. no treatment) status. With respect to needs for more information and sources of information, most (56.5%) participants received information about fertility issues before this study, with the most cited source of information being online research. Conclusions The current study replicated and extended previous findings on the reproductive attitudes and knowledge of TGE adolescents. Understanding the informational needs and priorities of adolescent TGE patients presenting for medical treatment will allow providers to give more robust patient education. This will, in turn, facilitate patients' ability to provide fully informed consent for treatment that aligns with their fertility and reproductive priorities and goals.
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Affiliation(s)
- Justin Halloran
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Alec M. Smidt
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Aimee Morrison
- Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Julia Cron
- Department of Obstetrics, Gynecology, & Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
| | - Amanda N. Kallen
- Department of Obstetrics, Gynecology, & Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
| | - Christy L. Olezeski
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
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Bayar E, Williams NJ, Alghrani A, Murugesu S, Saso S, Bracewell-Milnes T, Thum MY, Nicopoullos J, Sangster P, Yasmin E, Smith JR, Wilkinson S, Pacey A, Jones BP. Fertility preservation and realignment in transgender women. HUM FERTIL 2023; 26:463-482. [PMID: 36799335 DOI: 10.1080/14647273.2022.2163195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 09/01/2022] [Indexed: 02/18/2023]
Abstract
Medical care for transgender people is multi-faceted and attention to individual reproductive aspirations and planning are an essential, yet often overlooked aspect of care. Given the impact of hormonal therapy and other gender affirmation procedures on reproductive function, extensive counselling and consideration of fertility preservation is recommended prior to their commencement. This review article explores the reproductive aspirations of transgender women and considers the current disparity between stated desires regarding utilisation of fertility preservation services. Current fertility preservation options and prospective treatments currently showing promise in the research arena are explored.
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Affiliation(s)
- Erna Bayar
- Department of Gynaecology, Hammersmith Hospital, Imperial College NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Nicola J Williams
- Department of Politics, Philosophy and Religion, Lancaster University, Lancaster, UK
| | - Amel Alghrani
- School of Law and Social Justice, University of Liverpool, Liverpool, UK
| | - Sughashini Murugesu
- Department of Gynaecology, Hammersmith Hospital, Imperial College NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Srdjan Saso
- Department of Gynaecology, Hammersmith Hospital, Imperial College NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - Meen-Yau Thum
- Lister Fertility Clinic, The Lister Hospital, Chelsea Bridge Road, London, UK
| | - James Nicopoullos
- Lister Fertility Clinic, The Lister Hospital, Chelsea Bridge Road, London, UK
| | - Philippa Sangster
- Reproductive Medicine Unit, University College London Hospital, London, UK
| | - Ephia Yasmin
- Reproductive Medicine Unit, University College London Hospital, London, UK
| | - J Richard Smith
- Department of Gynaecology, Hammersmith Hospital, Imperial College NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Stephen Wilkinson
- Department of Politics, Philosophy and Religion, Lancaster University, Lancaster, UK
| | - Allan Pacey
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
| | - Benjamin P Jones
- Department of Gynaecology, Hammersmith Hospital, Imperial College NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
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12
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Kyweluk MA, Kirkley J, Grimstad F, Amato P, Downing J. Desire for genetically related children among transgender and gender-diverse patients seeking gender-affirming hormones. F S Rep 2023; 4:224-230. [PMID: 37398606 PMCID: PMC10310968 DOI: 10.1016/j.xfre.2023.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 04/10/2023] [Accepted: 04/10/2023] [Indexed: 07/04/2023] Open
Abstract
Objective To assess predictors of desire for genetically related children among a national cohort of reproductive-age transgender and gender-diverse patients aged 18 to 44 years initiating gender-affirming hormone therapy for the first time. Design Cross-sectional study. Setting National telehealth clinic. Patients A cohort of patients from 33 US states initiating gender-affirming hormone therapy. A total of 10,270 unique transgender and gender-diverse patients-aged 18 to 44 years (median age 24 years), with no prior use of gender-affirming hormone therapy-completed clinical intake forms between September 1, 2020, and January 1, 2022. Interventions Patient sex assigned at birth, insurance status, age, and geographic location. Main Outcome Measures Self-reported desire for children using own genetic material. Results Transgender and gender-diverse patients seeking gender-affirming medical treatments who are open to having genetically related children are an important population to identify and appropriately counsel. Over one quarter of the study population reported being interested in or unsure about having genetically related children, with 17.8% reporting yes and 8.4% unsure. Male-sex-assigned-at-birth patients had 1.37 (95% confidence interval: 1.25, 1.41) times higher odds of being open to having genetically related children compared with female-sex-assigned-at-birth patients. Those with private insurance had 1.13 (95% confidence interval: 1.02, 1.37) times higher odds of being open to having genetically related children compared with those without insurance. Conclusions These findings represent the largest source of self-reported data on the desire for genetically related children among reproductive-age adult transgender and gender-diverse patients seeking gender-affirming hormones. Guidelines recommend that providers offer fertility-related counseling. These results indicate that transgender and gender-diverse patients, particularly male-sex-assigned-at-birth individuals and patients with private insurance, could benefit from counseling regarding the impacts of gender-affirming hormone therapy and gender-affirming surgeries on fertility.
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Affiliation(s)
- Moira A. Kyweluk
- Plume Health, Denver, Colorado
- Third Space, LLC, Philadelphia, Pennsylvania
| | | | - Frances Grimstad
- Division of Gynecology, Department of Surgery, Boston Children’s Hospital, Cambridge, Massachusetts
- Department of Obstetrics, Gynecology, Reproductive Biology, Harvard Medical School, Cambridge, Massachusetts
| | - Paula Amato
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
| | - Jae Downing
- School of Public Health, Oregon Health & Science University, Portland, Oregon
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13
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Lipkin P, Monseur B, Mayo J, Moravek M, Nahata L, Amato P, Alvero R, Obedin-Maliver J. Reproductive endocrinologist and infertility specialists' knowledge, skills, behaviors, and attitudes regarding the care for transgender and gender-diverse individuals. F S Rep 2023; 4:213-223. [PMID: 37398621 PMCID: PMC10310934 DOI: 10.1016/j.xfre.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/19/2023] [Accepted: 03/29/2023] [Indexed: 07/04/2023] Open
Abstract
Objective To investigate associations between reproductive endocrinology and infertility (REI) providers' prior training and current knowledge, skills, attitudes, and behaviors regarding fertility preservation and family building for transgender and gender-diverse (T/GD) patients. Design The survey was distributed to members of the Society for Reproductive Endocrinology and Infertility, the REI-physician-focused professional body within the American Society for Reproductive Medicine, with additional participants recruited through snowball sampling. Results Participants (n = 206) reported on training in T/GD care; 51% endorsed prior training. Most participants (93%) believed T/GD individuals were as fit for parenthood as cisgender individuals. Prior training was associated with an increased likelihood of offering T/GD health resources and more frequent consultations with specialist colleagues.Common barriers to providing care indicated by respondents included cost, delays in gender-affirming care, and lack of knowledge of the potential impact of hormonal interventions. Common facilitators included education and training, prior experience, and affordability of services. Conclusions Most REI providers believed T/GD individuals are fit for parenthood and agreed that prior training facilitates care for T/GD patients. The lack of provider knowledge emerged as a barrier to care. Although training helped facilitate some components of care, systemic barriers such as the cost and variability of patient population characteristics/experiences are important considerations when serving T/GD individuals.
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Affiliation(s)
- Pip Lipkin
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, New York
| | - Brent Monseur
- Department of Obstetrics and Gynecology, Reproductive Endocrinology and Infertility Division, Stanford University School of Medicine, Palo Alto, California
| | - Jonathan Mayo
- Dunlevie Maternal-Fetal Medicine Center for Discovery, Innovation and Clinical Impact, Stanford University School of Medicine, Stanford, California
| | - Molly Moravek
- Department of Obstetrics and Gynecology, Reproductive Endocrinology and Infertility Division, University of Michigan Medical School, Ann Arbor, Michigan
| | - Leena Nahata
- Division of Pediatric Endocrinology, Nationwide Children’s Hospital, Columbus, Ohio
| | - Paula Amato
- Department of Obstetrics and Gynecology, Oregon Health Science University School of Medicine, Portland, Oregon
| | - Ruben Alvero
- Department of Obstetrics and Gynecology, Reproductive Endocrinology and Infertility Division, Stanford University School of Medicine, Palo Alto, California
| | - Juno Obedin-Maliver
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California
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14
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Kantor LZ, Tordoff DM, Haley SG, Crouch JM, Ahrens KR. Gender and Sexual Health-Related Knowledge Gaps and Educational Needs of Parents of Transgender and Non-Binary Youth. ARCHIVES OF SEXUAL BEHAVIOR 2023:10.1007/s10508-023-02611-9. [PMID: 37233838 DOI: 10.1007/s10508-023-02611-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 03/26/2023] [Accepted: 04/19/2023] [Indexed: 05/27/2023]
Abstract
Parents can have a substantial impact on adolescent sexual decision-making, but few studies have explored the role of parents in providing sexual health information to transgender and non-binary (TNB) youth, a population that experiences significant sexual and mental health disparities and lower levels of perceived family support compared with other youth. This study aimed to elucidate existing knowledge gaps and content deemed important for a sexual health curriculum and educational materials for parents of TNB youth. We conducted 21 qualitative interviews with five parents of TNB youth, 11 TNB youth aged 18+, and five healthcare affiliates to identify parents' educational needs. We analyzed the data using theoretical thematic analysis and consensus coding. Parents self-reported multiple knowledge deficits regarding gender/sexual health for TNB individuals and were primarily concerned with long-term impacts of medical interventions. Youth goals for parents included greater understanding of gender/sexuality and sufficient knowledge to support youth through social transition to their affirmed gender identity. Content areas suggested for a future curriculum for parents of TNB youth included: basics of gender/sexuality, diverse narratives of TNB experiences/identities, gender dysphoria, non-medical gender-affirming interventions, medical gender-affirming interventions, and resources for peer support. Parents desired access to accurate information and wanted to feel equipped to facilitate affirming conversations with their child, something that could combat health disparities among TNB youth. An educational curriculum for parents has the potential to provide a trusted information source, expose parents to positive representations of TNB individuals, and help parents support their TNB child through decisions about potential gender-affirming interventions.
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Affiliation(s)
- Lane Z Kantor
- David Geffen School of Medicine at the University of California Los Angeles, 10833 Le Conte Ave., Los Angeles, CA, 90095, USA.
| | - Diana M Tordoff
- Department of Epidemiology, Stanford University School of Medicine Palo Alto, Stanford, CA, USA
| | | | - Julia M Crouch
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Kym R Ahrens
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA
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15
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Chen L, Dong Z, Chen X. Fertility preservation in pediatric healthcare: a review. Front Endocrinol (Lausanne) 2023; 14:1147898. [PMID: 37206440 PMCID: PMC10189781 DOI: 10.3389/fendo.2023.1147898] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 04/12/2023] [Indexed: 05/21/2023] Open
Abstract
Survival rates for children and adolescents diagnosed with malignancy have been steadily increasing due to advances in oncology treatments. These treatments can have a toxic effect on the gonads. Currently, oocyte and sperm cryopreservation are recognized as well-established and successful strategies for fertility preservation for pubertal patients, while the use of gonadotropin-releasing hormone agonists for ovarian protection is controversial. For prepubertal girls, ovarian tissue cryopreservation is the sole option. However, the endocrinological and reproductive outcomes after ovarian tissue transplantation are highly heterogeneous. On the other hand, immature testicular tissue cryopreservation remains the only alternative for prepubertal boys, yet it is still experimental. Although there are several published guidelines for navigating fertility preservation for pediatric and adolescent patients as well as transgender populations, it is still restricted in clinical practice. This review aims to discuss the indications and clinical outcomes of fertility preservation. We also discuss the probably effective and efficient workflow to facilitate fertility preservation.
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Affiliation(s)
- Lin Chen
- Reproductive Medical Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zirui Dong
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
| | - Xiaoyan Chen
- Maternal-Fetal Medicine Institute, Shenzhen Baoan Women’s and Children’s Hospital, Shenzhen University, Shenzhen, China
- The Fertility Preservation Research Center, Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
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16
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Lambert A, Pratt A, Conard LAE, Grigg Dean E, Page E, Vaughn LM, Lipstein EA. Supporting Gender-Related Medical Decision Making for Transgender and Gender-Diverse Individuals: A Scoping Review. Transgend Health 2023; 8:113-123. [PMID: 37013094 PMCID: PMC10066778 DOI: 10.1089/trgh.2021.0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose Transgender and gender-diverse (TGD) individuals and their families face numerous challenging decisions. To better understand their decision processes, we conducted a scoping review of the existing literature and of decision-support tools in use at pediatric gender-care clinics. Methods We searched PubMed, EMBASE, Scopus CINAHL, PsychINFO, and EBM Reviews for studies that were original research focused on decisions, decision making, or decision support for TGD individuals and/or their families. All studies were reviewed for inclusion by at least two researchers. Additionally, we reviewed clinical tools used to support decision making by TGD youth and their families. Results We retrieved 3306 articles. Thirty-two met criteria for data extraction. Studies focused on three major decisions: gender-confirming surgery, fertility preservation, and gender-affirming hormone therapy. Several themes that cut across clinical topics emerged: decision-making processes, decision-making roles, and sources of decision support. Only three articles focused on decision-support interventions, two of which discussed development of support tools and one evaluated a class designed to help with surgical decision making. None of the clinical tools reviewed met criteria for a decision aid. Conclusions There is a dearth of studies related to decision support interventions, an absence validated by the resources currently in clinical use. This scoping review suggests an opportunity for the development of tools to aid in the decision-making processes for TGD youth and their families.
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Affiliation(s)
- Amy Lambert
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Ashli Pratt
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Lee Ann E. Conard
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Elaine Grigg Dean
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Erica Page
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Lisa M. Vaughn
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Ellen A. Lipstein
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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17
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Bouzy J, Brunelle J, Cohen D, Condat A. Transidentities and autism spectrum disorder: A systematic review. Psychiatry Res 2023; 323:115176. [PMID: 36996732 DOI: 10.1016/j.psychres.2023.115176] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/13/2023] [Accepted: 03/18/2023] [Indexed: 04/01/2023]
Abstract
Transidentity and autism frequently co-occur. Previous reviews have focused mainly on frequencies. Here, we conducted a systematic review to condense all the studies and themes on this co-occurrence and to offer a global view. We followed the PRISMA method and selected 77 articles (including 59 clinical studies) in April 2022. We found 5 main themes (sex ratio, theories, sexual orientation, clinical and social consequences, and care implications) in addition to frequencies. Many theories have been proposed to explain the co-occurrence. One posits that social difficulties related to autism would lead to less identification with gender norms and less pressure to conform to these norms, allowing for greater gender diversity in people with autism. Given their difficulties with social interactions and communication, the announcement of one's transidentity to one's social group is often discredited, increasing the risk of suffering and delayed care. Many reports reaffirm the importance of providing specialised care for transgender people with autism. Autism is not a contraindication for gender-affirming treatment. However, some cognitive specificities can affect the planning of care, and transgender people with autism are at high risk of discrimination and harassment. We conclude that there is a need to raise awareness about gender and autism.
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Affiliation(s)
- Juliette Bouzy
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
| | - Julie Brunelle
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
| | - David Cohen
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France; Institut des Systèmes Intelligents et de Robotiques, Université Pierre et Marie Curie, Paris, France.
| | - Agnès Condat
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France; UR14 "Santé et droits sexuels et reproductifs", Ined, Paris, France
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18
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Lowik A, Al-anzi SMF, Amarasekera A, Chan A, Rana M, Salter A, Nath R, Ybarra M, Saewyc E. Transgender Youth's Perspectives on Factors Influencing Intended and Unintended Pregnancies. WOMEN'S REPRODUCTIVE HEALTH (PHILADELPHIA, PA.) 2023; 10:572-590. [PMID: 38435846 PMCID: PMC10906744 DOI: 10.1080/23293691.2023.2186812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 02/27/2023] [Indexed: 03/05/2024]
Abstract
Drawing on data from focus groups with 152 trans youth aged 14-18 years in the United States, this article explores the factors that the participants understood as contributing to adolescent pregnancy among trans youth. Youth posited that unintended pregnancies occur due to barriers to contraceptives; a lack of gender-affirming sexual health education; sexual assault and dating violence; and mental health-influenced sexual risk-taking. Participants suggested that intended pregnancies may be a self-development strategy; a self-directed effort to repress/change gender modality or identity; and due to the perceived incompatibility between pregnancy and transition, where pregnancy must occur prior to transitioning.
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Affiliation(s)
- A.J. Lowik
- Stigma and Resilience Among Vulnerable Youth Centre, University of British Columbia, Vancouver, Canada
| | - Shams M. F. Al-anzi
- Stigma and Resilience Among Vulnerable Youth Centre, University of British Columbia, Vancouver, Canada
| | - Anurada Amarasekera
- Stigma and Resilience Among Vulnerable Youth Centre, University of British Columbia, Vancouver, Canada
| | - Ace Chan
- Stigma and Resilience Among Vulnerable Youth Centre, University of British Columbia, Vancouver, Canada
| | - Monica Rana
- Stigma and Resilience Among Vulnerable Youth Centre, University of British Columbia, Vancouver, Canada
| | - Allison Salter
- Center for Innovative Public Health Research, San Clemente, California
| | - Ronita Nath
- Stigma and Resilience Among Vulnerable Youth Centre, University of British Columbia, Vancouver, Canada
| | - Michele Ybarra
- Center for Innovative Public Health Research, San Clemente, California
| | - Elizabeth Saewyc
- Stigma and Resilience Among Vulnerable Youth Centre, University of British Columbia, Vancouver, Canada
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19
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Stolk THR, Asseler JD, Huirne JAF, van den Boogaard E, van Mello NM. Desire for children and fertility preservation in transgender and gender-diverse people: A systematic review. Best Pract Res Clin Obstet Gynaecol 2023; 87:102312. [PMID: 36806443 DOI: 10.1016/j.bpobgyn.2023.102312] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/30/2022] [Accepted: 01/13/2023] [Indexed: 01/22/2023]
Abstract
The decision to pursue one's desire for children is a basic human right. For transgender and gender-diverse (TGD) people, gender-affirming care may alter the possibilities to fulfill one's desire for children due to the impact of this treatment on their reproductive organs. We systematically included 76 studies of varying quality describing the desire for children and parenthood; fertility counseling and utilization; and fertility preservation options and outcomes in TGD people. The majority of TGD people expressed a desire for children. Fertility preservation utilization rates were low as there are many barriers to pursue fertility preservation. The most utilized fertility preservation strategies include oocyte vitrification and sperm banking through masturbation. Oocyte vitrification showed successful outcomes, even after testosterone cessation. Sperm analyses when banking sperm showed a lower quality compared to cis male samples even prior to gender-affirming hormone treatment and an uncertain recovery of spermatogenesis after discontinuing treatment.
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Affiliation(s)
- T H R Stolk
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Center of Expertise on Gender Dysphoria, De Boelelaan 1117, Amsterdam University Medical Centers, the Netherlands; Amsterdam UMC, Department of Obstetrics & Gynaecology, Amsterdam, the Netherlands; Amsterdam Reproduction and Development, Amsterdam, the Netherlands.
| | - J D Asseler
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Center of Expertise on Gender Dysphoria, De Boelelaan 1117, Amsterdam University Medical Centers, the Netherlands; Amsterdam UMC, Department of Obstetrics & Gynaecology, Amsterdam, the Netherlands; Amsterdam Reproduction and Development, Amsterdam, the Netherlands.
| | - J A F Huirne
- Amsterdam UMC, Department of Obstetrics & Gynaecology, 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, De Boelelaan 1117, Amsterdam University Medical Centers, the Netherlands; Amsterdam UMC, Department of Obstetrics & Gynaecology, 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, De Boelelaan 1117, Amsterdam University Medical Centers, the Netherlands; Amsterdam UMC, Department of Obstetrics & Gynaecology, Amsterdam, the Netherlands; Amsterdam Reproduction and Development, Amsterdam, the Netherlands.
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20
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Jung C, Hunter A, Saleh M, Quinn GP, Nippita S. Breaking the Binary: How Clinicians Can Ensure Everyone Receives High Quality Reproductive Health Services. Open Access J Contracept 2023; 14:23-39. [PMID: 36814801 PMCID: PMC9939798 DOI: 10.2147/oajc.s368621] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 01/30/2023] [Indexed: 02/17/2023] Open
Abstract
The gender binary has historically defined the study and practice of reproductive and sexual healthcare. However, the male and female binary categorization of sex does not adequately define patients seeking reproductive and sexual health. Comprehensive sexual healthcare should consider diverse gender identity and non-heteronormative sexual practices, family planning, sexually transmitted infections, cancer prevention, and sexual function. Recent research suggests clinicians do not feel prepared to provide care for sexual and gender minority (SGM) patients. In this narrative review, we focus on reproductive and sexual health within the scope of obstetric and gynecologic (OB/GYN) clinical practice. We used traditional medical subject headings to summarize data from publications in peer-reviewed journals published in the last 10 years and identified barriers, facilitators and best practices for de-gendering reproductive healthcare. Following a roughly chronological care path across the lifespan, we categorized findings into the following topics: Early Care for SGM, Sexual Health, Family Planning, and Care Later in Life for SGM. We include recommendations for creating a welcoming environment, SGM inclusive training for clinicians and staff, and best practices for individualized counseling. We review suggested practices related to service delivery and clinical considerations in the provision of sexual and reproductive health care for gender and sexual minority patients.
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Affiliation(s)
- Christina Jung
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, NY, USA
| | - Adam Hunter
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, NY, USA
| | - Mona Saleh
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gwendolyn P Quinn
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, NY, USA,Correspondence: Gwendolyn P Quinn, Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, 550 1st Ave NBV N91-F, New York, NY, 10016, USA, Tel +1-646-501-6878, Email
| | - Siripanth Nippita
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, NY, USA
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21
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Abstract
A growing number of adolescents in the United States identify as transgender and gender nonbinary, and many will seek medical management of menstruation. In this evidence-based review, we recommend a model of gender-affirming care grounded in the tenants of reproductive justice, emphasizing patient autonomy and the development of holistic management plans centered around the patient's unique goals for affirming their gender identity. We then review strategies for achieving menstruation suppression for transgender and gender nonbinary adolescents, including dosing considerations, menstruation, ovulation, contraceptive effects, and metabolic considerations specific to the adolescent population.
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22
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Dilday EA, Bukulmez O, Saner K, Lopez X, Jarin J. Sperm Cryopreservation Outcomes in Transgender Adolescents Compared with Adolescents Receiving Gonadotoxic Therapy. Transgend Health 2022; 7:528-532. [PMID: 36644123 PMCID: PMC9829158 DOI: 10.1089/trgh.2021.0037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Purpose The target population for fertility preservation recently has been expanded from adolescents with cancer undergoing gonadotoxic chemotherapy to include transgender youth before initiating gender-affirming hormone therapy. Patients and providers may have knowledge deficits regarding options for fertility preservation, accessibility, and feasibility of its techniques, and impact of treatment on future fertility. This study describes outcomes of sperm cryopreservation in transgender male-to-female (affirmed female) youth and compares semen parameters with adolescents diagnosed with cancer. Methods Medical records of transgender-affirmed female adolescents and adolescent males diagnosed with cancer who underwent sperm cryopreservation at the Fertility and Advanced Reproductive Medicine clinic of the University of Texas (UT) Southwestern Medical Center between March 2015 and March 2020 were reviewed. Demographic data were recorded and values for sperm parameters (volume, count, total count, motility (%), total motile) were collected. When available, hormone levels (luteinizing hormone, follicle-stimulating hormone, testosterone, and estradiol) and Tanner stages were also assessed. The two populations were compared using chi-square analysis and two-sample student's t-test. Data are presented as mean±standard deviation. Results While semen quality parameters trended lower in transgender youth compared with adolescents with cancer, there was no statistically significant difference between groups. While four out of 18 patients in the transgender group had azoospermia, mean semen quality parameters fell within normal adult reference ranges for both groups. Conclusion Sperm cryopreservation for transgender youth and adolescents with cancer is feasible, inexpensive, and does not result in significant treatment delays. This information can improve counseling and access to these procedures, particularly in the transgender population.
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Affiliation(s)
- Elizabeth A. Dilday
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Orhan Bukulmez
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Karla Saner
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ximena Lopez
- Department of Pediatrics, Children's Health, Dallas, Texas, USA
| | - Jason Jarin
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Pediatrics, Children's Health, Dallas, Texas, USA
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Coleman E, Radix AE, Bouman WP, Brown GR, de Vries ALC, Deutsch MB, Ettner R, Fraser L, Goodman M, Green J, Hancock AB, Johnson TW, Karasic DH, Knudson GA, Leibowitz SF, Meyer-Bahlburg HFL, Monstrey SJ, Motmans J, Nahata L, Nieder TO, Reisner SL, Richards C, Schechter LS, Tangpricha V, Tishelman AC, Van Trotsenburg MAA, Winter S, Ducheny K, Adams NJ, Adrián TM, Allen LR, Azul D, Bagga H, Başar K, Bathory DS, Belinky JJ, Berg DR, Berli JU, Bluebond-Langner RO, Bouman MB, Bowers ML, Brassard PJ, Byrne J, Capitán L, Cargill CJ, Carswell JM, Chang SC, Chelvakumar G, Corneil T, Dalke KB, De Cuypere G, de Vries E, Den Heijer M, Devor AH, Dhejne C, D'Marco A, Edmiston EK, Edwards-Leeper L, Ehrbar R, Ehrensaft D, Eisfeld J, Elaut E, Erickson-Schroth L, Feldman JL, Fisher AD, Garcia MM, Gijs L, Green SE, Hall BP, Hardy TLD, Irwig MS, Jacobs LA, Janssen AC, Johnson K, Klink DT, Kreukels BPC, Kuper LE, Kvach EJ, Malouf MA, Massey R, Mazur T, McLachlan C, Morrison SD, Mosser SW, Neira PM, Nygren U, Oates JM, Obedin-Maliver J, Pagkalos G, Patton J, Phanuphak N, Rachlin K, Reed T, Rider GN, Ristori J, Robbins-Cherry S, Roberts SA, Rodriguez-Wallberg KA, Rosenthal SM, Sabir K, Safer JD, Scheim AI, Seal LJ, Sehoole TJ, Spencer K, St Amand C, Steensma TD, Strang JF, Taylor GB, Tilleman K, T'Sjoen GG, Vala LN, Van Mello NM, Veale JF, Vencill JA, Vincent B, Wesp LM, West MA, Arcelus J. Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2022; 23:S1-S259. [PMID: 36238954 PMCID: PMC9553112 DOI: 10.1080/26895269.2022.2100644] [Citation(s) in RCA: 674] [Impact Index Per Article: 337.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Background: Transgender healthcare is a rapidly evolving interdisciplinary field. In the last decade, there has been an unprecedented increase in the number and visibility of transgender and gender diverse (TGD) people seeking support and gender-affirming medical treatment in parallel with a significant rise in the scientific literature in this area. The World Professional Association for Transgender Health (WPATH) is an international, multidisciplinary, professional association whose mission is to promote evidence-based care, education, research, public policy, and respect in transgender health. One of the main functions of WPATH is to promote the highest standards of health care for TGD people through the Standards of Care (SOC). The SOC was initially developed in 1979 and the last version (SOC-7) was published in 2012. In view of the increasing scientific evidence, WPATH commissioned a new version of the Standards of Care, the SOC-8. Aim: The overall goal of SOC-8 is to provide health care professionals (HCPs) with clinical guidance to assist TGD people in accessing safe and effective pathways to achieving lasting personal comfort with their gendered selves with the aim of optimizing their overall physical health, psychological well-being, and self-fulfillment. Methods: The SOC-8 is based on the best available science and expert professional consensus in transgender health. International professionals and stakeholders were selected to serve on the SOC-8 committee. Recommendation statements were developed based on data derived from independent systematic literature reviews, where available, background reviews and expert opinions. Grading of recommendations was based on the available evidence supporting interventions, a discussion of risks and harms, as well as the feasibility and acceptability within different contexts and country settings. Results: A total of 18 chapters were developed as part of the SOC-8. They contain recommendations for health care professionals who provide care and treatment for TGD people. Each of the recommendations is followed by explanatory text with relevant references. General areas related to transgender health are covered in the chapters Terminology, Global Applicability, Population Estimates, and Education. The chapters developed for the diverse population of TGD people include Assessment of Adults, Adolescents, Children, Nonbinary, Eunuchs, and Intersex Individuals, and people living in Institutional Environments. Finally, the chapters related to gender-affirming treatment are Hormone Therapy, Surgery and Postoperative Care, Voice and Communication, Primary Care, Reproductive Health, Sexual Health, and Mental Health. Conclusions: The SOC-8 guidelines are intended to be flexible to meet the diverse health care needs of TGD people globally. While adaptable, they offer standards for promoting optimal health care and guidance for the treatment of people experiencing gender incongruence. As in all previous versions of the SOC, the criteria set forth in this document for gender-affirming medical interventions are clinical guidelines; individual health care professionals and programs may modify these in consultation with the TGD person.
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Affiliation(s)
- E Coleman
- Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - A E Radix
- Callen-Lorde Community Health Center, New York, NY, USA
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - W P Bouman
- Nottingham Centre for Transgender Health, Nottingham, UK
- School of Medicine, University of Nottingham, Nottingham, UK
| | - G R Brown
- James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
- James H. Quillen VAMC, Johnson City, TN, USA
| | - A L C de Vries
- Department of Child and Adolescent Psychiatry, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M B Deutsch
- Department of Family & Community Medicine, University of California-San Francisco, San Francisco, CA, USA
- UCSF Gender Affirming Health Program, San Francisco, CA, USA
| | - R Ettner
- New Health Foundation Worldwide, Evanston, IL, USA
- Weiss Memorial Hospital, Chicago, IL, USA
| | - L Fraser
- Independent Practice, San Francisco, CA, USA
| | - M Goodman
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - J Green
- Independent Scholar, Vancouver, WA, USA
| | - A B Hancock
- The George Washington University, Washington, DC, USA
| | - T W Johnson
- Department of Anthropology, California State University, Chico, CA, USA
| | - D H Karasic
- University of California San Francisco, San Francisco, CA, USA
- Independent Practice at dankarasic.com
| | - G A Knudson
- University of British Columbia, Vancouver, Canada
- Vancouver Coastal Health, Vancouver, Canada
| | - S F Leibowitz
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - H F L Meyer-Bahlburg
- New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, Columbia University, New York, NY, USA
| | | | - J Motmans
- Transgender Infopunt, Ghent University Hospital, Gent, Belgium
- Centre for Research on Culture and Gender, Ghent University, Gent, Belgium
| | - L Nahata
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
- Endocrinology and Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - T O Nieder
- University Medical Center Hamburg-Eppendorf, Interdisciplinary Transgender Health Care Center Hamburg, Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, Hamburg, Germany
| | - S L Reisner
- Harvard Medical School, Boston, MA, USA
- Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - C Richards
- Regents University London, UK
- Tavistock and Portman NHS Foundation Trust, London, UK
| | | | - V Tangpricha
- Division of Endocrinology, Metabolism & Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Atlanta VA Medical Center, Decatur, GA, USA
| | - A C Tishelman
- Boston College, Department of Psychology and Neuroscience, Chestnut Hill, MA, USA
| | - M A A Van Trotsenburg
- Bureau GenderPRO, Vienna, Austria
- University Hospital Lilienfeld-St. Pölten, St. Pölten, Austria
| | - S Winter
- School of Population Health, Curtin University, Perth, WA, Australia
| | - K Ducheny
- Howard Brown Health, Chicago, IL, USA
| | - N J Adams
- University of Toronto, Ontario Institute for Studies in Education, Toronto, Canada
- Transgender Professional Association for Transgender Health (TPATH)
| | - T M Adrián
- Asamblea Nacional de Venezuela, Caracas, Venezuela
- Diverlex Diversidad e Igualdad a Través de la Ley, Caracas, Venezuela
| | - L R Allen
- University of Nevada, Las Vegas, NV, USA
| | - D Azul
- La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - H Bagga
- Monash Health Gender Clinic, Melbourne, Victoria, Australia
- Monash University, Melbourne, Victoria, Australia
| | - K Başar
- Department of Psychiatry, Hacettepe University, Ankara, Turkey
| | - D S Bathory
- Independent Practice at Bathory International PLLC, Winston-Salem, NC, USA
| | - J J Belinky
- Durand Hospital, Guemes Clinic and Urological Center, Buenos Aires, Argentina
| | - D R Berg
- National Center for Gender Spectrum Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - J U Berli
- Oregon Health & Science University, Portland, OR, USA
| | - R O Bluebond-Langner
- NYU Langone Health, New York, NY, USA
- Hansjörg Wyss Department of Plastic Surgery, New York, NY, USA
| | - M-B Bouman
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Plastic Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - M L Bowers
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mills-Peninsula Medical Center, Burlingame, CA, USA
| | - P J Brassard
- GrS Montreal, Complexe CMC, Montreal, Quebec, Canada
- Université de Montreal, Quebec, Canada
| | - J Byrne
- University of Waikato/Te Whare Wānanga o Waikato, Hamilton/Kirikiriroa, New Zealand/Aotearoa
| | - L Capitán
- The Facialteam Group, Marbella International Hospital, Marbella, Spain
| | | | - J M Carswell
- Harvard Medical School, Boston, MA, USA
- Boston's Children's Hospital, Boston, MA, USA
| | - S C Chang
- Independent Practice, Oakland, CA, USA
| | - G Chelvakumar
- Nationwide Children's Hospital, Columbus, OH, USA
- The Ohio State University, College of Medicine, Columbus, OH, USA
| | - T Corneil
- School of Population & Public Health, University of British Columbia, Vancouver, BC, Canada
| | - K B Dalke
- Penn State Health, PA, USA
- Penn State College of Medicine, Hershey, PA, USA
| | - G De Cuypere
- Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium
| | - E de Vries
- Nelson Mandela University, Gqeberha, South Africa
- University of Cape Town, Cape Town, South Africa
| | - M Den Heijer
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Endocrinology, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - A H Devor
- University of Victoria, Victoria, BC, Canada
| | - C Dhejne
- ANOVA, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - A D'Marco
- UCTRANS-United Caribbean Trans Network, Nassau, The Bahamas
- D M A R C O Organization, Nassau, The Bahamas
| | - E K Edmiston
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - L Edwards-Leeper
- Pacific University, Hillsboro, OR, USA
- Independent Practice, Beaverton, OR, USA
| | - R Ehrbar
- Whitman Walker Health, Washington, DC, USA
- Independent Practice, Maryland, USA
| | - D Ehrensaft
- University of California San Francisco, San Francisco, CA, USA
| | - J Eisfeld
- Transvisie, Utrecht, The Netherlands
| | - E Elaut
- Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium
- Department of Clinical Experimental and Health Psychology, Ghent University, Gent, Belgium
| | - L Erickson-Schroth
- The Jed Foundation, New York, NY, USA
- Hetrick-Martin Institute, New York, NY, USA
| | - J L Feldman
- Institute for Sexual and Gender Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - A D Fisher
- Andrology, Women Endocrinology and Gender Incongruence, Careggi University Hospital, Florence, Italy
| | - M M Garcia
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Departments of Urology and Anatomy, University of California San Francisco, San Francisco, CA, USA
| | - L Gijs
- Institute of Family and Sexuality Studies, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | | | - B P Hall
- Duke University Medical Center, Durham, NC, USA
- Duke Adult Gender Medicine Clinic, Durham, NC, USA
| | - T L D Hardy
- Alberta Health Services, Edmonton, Alberta, Canada
- MacEwan University, Edmonton, Alberta, Canada
| | - M S Irwig
- Harvard Medical School, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - A C Janssen
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - K Johnson
- RMIT University, Melbourne, Australia
- University of Brighton, Brighton, UK
| | - D T Klink
- Department of Pediatrics, Division of Pediatric Endocrinology, Ghent University Hospital, Gent, Belgium
- Division of Pediatric Endocrinology and Diabetes, ZNA Queen Paola Children's Hospital, Antwerp, Belgium
| | - B P C Kreukels
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - L E Kuper
- Department of Psychiatry, Southwestern Medical Center, University of Texas, Dallas, TX, USA
- Department of Endocrinology, Children's Health, Dallas, TX, USA
| | - E J Kvach
- Denver Health, Denver, CO, USA
- University of Colorado School of Medicine, Aurora, CO, USA
| | - M A Malouf
- Malouf Counseling and Consulting, Baltimore, MD, USA
| | - R Massey
- WPATH Global Education Institute
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - T Mazur
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- John R. Oishei Children's Hospital, Buffalo, NY, USA
| | - C McLachlan
- Professional Association for Transgender Health, South Africa
- Gender DynamiX, Cape Town, South Africa
| | - S D Morrison
- Division of Plastic Surgery, Seattle Children's Hospital, Seattle, WA, USA
- Division of Plastic Surgery, Department of Surgery, University of Washington Medical Center, Seattle, WA, USA
| | - S W Mosser
- Gender Confirmation Center, San Francisco, CA, USA
- Saint Francis Memorial Hospital, San Francisco, CA, USA
| | - P M Neira
- Johns Hopkins Center for Transgender Health, Baltimore, MD, USA
- Johns Hopkins Medicine Office of Diversity, Inclusion and Health Equity, Baltimore, MD, USA
| | - U Nygren
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Speech and Language Pathology, Medical Unit, Karolinska University Hospital, Stockholm, Sweden
| | - J M Oates
- La Trobe University, Melbourne, Australia
- Melbourne Voice Analysis Centre, East Melbourne, Australia
| | - J Obedin-Maliver
- Stanford University School of Medicine, Department of Obstetrics and Gynecology, Palo Alto, CA, USA
- Department of Epidemiology and Population Health, Stanford, CA, USA
| | - G Pagkalos
- Independent PracticeThessaloniki, Greece
- Military Community Mental Health Center, 424 General Military Training Hospital, Thessaloniki, Greece
| | - J Patton
- Talkspace, New York, NY, USA
- CytiPsychological LLC, San Diego, CA, USA
| | - N Phanuphak
- Institute of HIV Research and Innovation, Bangkok, Thailand
| | - K Rachlin
- Independent Practice, New York, NY, USA
| | - T Reed
- Gender Identity Research and Education Society, Leatherhead, UK
| | - G N Rider
- National Center for Gender Spectrum Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - J Ristori
- Andrology, Women Endocrinology and Gender Incongruence, Careggi University Hospital, Florence, Italy
| | | | - S A Roberts
- Harvard Medical School, Boston, MA, USA
- Division of Endocrinology, Boston's Children's Hospital, Boston, MA, USA
| | - K A Rodriguez-Wallberg
- Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | - S M Rosenthal
- Division of Pediatric Endocrinology, UCSF, San Francisco, CA, USA
- UCSF Child and Adolescent Gender Center
| | - K Sabir
- FtM Phoenix Group, Krasnodar Krai, Russia
| | - J D Safer
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mount Sinai Center for Transgender Medicine and Surgery, New York, NY, USA
| | - A I Scheim
- Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
- Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, Ontario, Canada
| | - L J Seal
- Tavistock and Portman NHS Foundation Trust, London, UK
- St George's University Hospitals NHS Foundation Trust, London, UK
| | | | - K Spencer
- National Center for Gender Spectrum Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - C St Amand
- University of Houston, Houston, TX, USA
- Mayo Clinic, Rochester, MN, USA
| | - T D Steensma
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - J F Strang
- Children's National Hospital, Washington, DC, USA
- George Washington University School of Medicine, Washington, DC, USA
| | - G B Taylor
- Atrium Health Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Charlotte, NC, USA
| | - K Tilleman
- Department for Reproductive Medicine, Ghent University Hospital, Gent, Belgium
| | - G G T'Sjoen
- Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium
- Department of Endocrinology, Ghent University Hospital, Gent, Belgium
| | - L N Vala
- Independent Practice, Campbell, CA, USA
| | - N M Van Mello
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - J F Veale
- School of Psychology, University of Waikato/Te Whare Wānanga o Waikato, Hamilton/Kirikiriroa, New Zealand/Aotearoa
| | - J A Vencill
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - B Vincent
- Trans Learning Partnership at https://spectra-london.org.uk/trans-learning-partnership, UK
| | - L M Wesp
- College of Nursing, University of Wisconsin MilwaukeeMilwaukee, WI, USA
- Health Connections Inc., Glendale, WI, USA
| | - M A West
- North Memorial Health Hospital, Robbinsdale, MN, USA
- University of Minnesota, Minneapolis, MN, USA
| | - J Arcelus
- School of Medicine, University of Nottingham, Nottingham, UK
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
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Ker A, Shaw RM, Byrne J, Veale J. Access to fertility preservation for trans and non-binary people in Aotearoa New Zealand. CULTURE, HEALTH & SEXUALITY 2022; 24:1273-1288. [PMID: 34253148 DOI: 10.1080/13691058.2021.1944670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 06/14/2021] [Indexed: 06/13/2023]
Abstract
There is a growing need for healthcare professionals to discuss fertility preservation options with trans and non-binary people before commencing medical transition as part of informed consent-based models of care. In this article, we adapt the Five-A framework of healthcare access to examine fertility preservation information and services. To do so, we present an analysis of data from Counting Ourselves, the first comprehensive national survey in Aotearoa New Zealand of trans and non-binary people's health and the first study exploring their access to cryopreservation information and services. Among 419 participants who had received gender-affirming hormones or surgery, 33.7% received information about options for fertility preservation and 15.8% accessed fertility preservation services. Findings from the study indicate the need for greater understanding of trans and non-binary people's desire for genetically related children, and what type of information and form of delivery would be most helpful to ensure equitable outcomes in relation to decision-making around fertility and future family-building.
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Affiliation(s)
- Alex Ker
- School of Social and Cultural Studies, Victoria University of Wellington, Wellington, New Zealand
| | - Rhonda M Shaw
- School of Social and Cultural Studies, Victoria University of Wellington, Wellington, New Zealand
| | - Jack Byrne
- Trans Health Research Lab and School of Psychology, University of Waikato, Hamilton, New Zealand
| | - Jaimie Veale
- Trans Health Research Lab and School of Psychology, University of Waikato, Hamilton, New Zealand
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Garborcauskas G, McCabe E, Boskey ER, Grimstad FW. Family Building Perspectives of Assigned Female at Birth Transgender and Gender Diverse Adolescents Seeking Testosterone Gender-Affirming Hormone Therapy. LGBT Health 2022; 9:463-470. [PMID: 35802494 DOI: 10.1089/lgbt.2022.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Purpose: The purpose of this study was to assess the future family building desires of assigned female at birth (AFAB) transgender and gender diverse (TGD) adolescents initiating hormone therapy, and to characterize the individuals interested in adoption. Methods: This was a retrospective chart review of AFAB TGD adolescents ages 15-17 years old initiating testosterone gender-affirming hormone therapy between 2010 and 2019, analyzing interest in adoption, demographics, and gender-affirming care. Results: Of 195 AFAB TGD adolescents asked about family planning goals, 58% (n = 113) indicated desire for adoption in their future, and 13.3% (n = 26) had no desire for children. There was no difference between those who did and did not want to adopt in terms of age at time of first visit (p = 0.22), or race distribution (p = 0.45); however, straight-identified patients were more likely to desire adoption (p = 0.02) than people with other sexual orientations. Fifty-nine percent (n = 110) of those who did not have a history of adoption and/or experience with the child welfare system desired adoption, compared with 22% (n = 2) of those with a history (odds ratio, 5.14; 95% confidence interval, 1.04-25.39; p = 0.05). Conclusion: Some AFAB TGD adolescents endorse adoption as their desired pathway to parenthood. Clinicians should be sensitive to the complexities of parenthood desires of AFAB TGD patients and have resources to direct patients to more information. Further research is needed to better understand why many AFAB TGD adolescents desire adoption, how this changes with age, and the barriers they face in achieving their goals.
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Affiliation(s)
- Garrett Garborcauskas
- Department of Medical Sciences, Frank H. Netter School of Medicine at Quinnipiac University, North Haven, Connecticut, USA
| | - Elio McCabe
- Department of Law, Quinnipiac University School of Law, North Haven, Connecticut, USA
| | - Elizabeth R Boskey
- Department of Law, Center for Gender Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Frances W Grimstad
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, Massachusetts, USA
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Sexual and Reproductive Health for Transgender and Gender-Diverse Patients. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2022. [DOI: 10.1007/s13669-022-00333-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Cooper HC, Long J, Aye T. Fertility preservation in transgender and non-binary adolescents and young adults. PLoS One 2022; 17:e0265043. [PMID: 35275955 PMCID: PMC8916634 DOI: 10.1371/journal.pone.0265043] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 02/22/2022] [Indexed: 11/18/2022] Open
Abstract
Although 37.5–51% of transgender adults state they would’ve considered freezing gametes before gender-affirming therapy if offered and 24–25.8% of transgender adolescents express interest in having biological children, less than 5% of transgender adolescents have opted for fertility preservation. We sought to assess fertility preservation utilization in our multidisciplinary adolescent gender clinic. We also aimed to identify fertility preservation utilization and interest among non-binary adolescents and young adults. A retrospective review was conducted of patients seen in the Stanford Pediatric & Adolescent Gender Clinic from October 2015 through March 2019 who were >10 years of age at initial visit. All individuals with documented discussion of fertility preservation were offered referral for formal fertility preservation consultation but only 24% of patients accepted. Only 6.8% of individuals subsequently underwent fertility preservation (n = 9). Transfeminine adolescents are more likely to pursue fertility preservation than transmasculine adolescents (p = 0.01). The rate of fertility preservation in non-binary adolescents did not significantly differ from those in transfeminine adolescents (p = 1.00) or transmasculine adolescents (p = 0.31). Although only one non-binary individual underwent fertility preservation, several more expressed interest with 36% accepting referral (n = 4) and 27% being seen in consultation (n = 3). Despite offering fertility preservation with designated members of a gender clinic team, utilization remains low in transgender adolescents. Additionally, non-binary adolescents and their families are interested in fertility preservation and referrals should be offered to these individuals. Further studies and advocacy are required to continue to address fertility needs of transgender adolescents.
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Affiliation(s)
- Holly C. Cooper
- Department of Pediatric Endocrinology, Mary Bridge Children’s Hospital, Tacoma, Washington, United States of America
- * E-mail:
| | - Jin Long
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, United States of America
| | - Tandy Aye
- Department of Pediatric Endocrinology, Mary Bridge Children’s Hospital, Tacoma, Washington, United States of America
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Rodriguez-Wallberg K, Obedin-Maliver J, Taylor B, Van Mello N, Tilleman K, Nahata L. Reproductive health in transgender and gender diverse individuals: A narrative review to guide clinical care and international guidelines. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2022; 24:7-25. [PMID: 36713139 PMCID: PMC9879176 DOI: 10.1080/26895269.2022.2035883] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Background Hormonal treatments and surgical interventions practiced with the aim to affirm gender identity in transgender and gender diverse patients may impact their future reproductive ability, family building, and family planning options. Whereas it is recommended by international guidelines to discuss the potential risks of infertility and to present fertility preservation (FP) options to transgender individuals and their families prior to initiating any of these treatments, many barriers still remain. Further, transgender and gender diverse individuals often experience barriers to accessing contraception, abortion, pre-conception care, and comprehensive perinatal care. Aims In this review we summarize the current literature on reproductive healthcare issues reported in transgender people including fertility issues, fertility preservation (FP), contraception, pregnancy and lactation and perinatal health. Methods A narrative literature search of major databases (Pubmed, Medline, PsycInfo, Google Scholar, Web of Science) was conducted. Given the paucity and heterogeneity of studies, summative review tactics were not available. The literature was critically reviewed by international experts in the field with focus on the impact of gender-affirming medical interventions on future fertility, current FP options and reproductive health issues in transgender people. Results The current literature supports that transgender and gender diverse individuals may wish to have genetically related children in the future, rendering the issue of FP relevant to this patient group. The cryopreservation of mature gametes is an efficacious option for FP for post-pubertal adolescents and adults. It is recommended to discuss these options at time of planning for gender-affirming hormonal therapy (GAHT) or engaging with other gender-affirming procedures that can limit future fertility. Discontinuation of GAHT may allow individuals to undergo FP later, but data are limited and there is the concern of symptoms and consequences of stopping GAHT. For pre-pubertal and early pubertal children, FP options are limited to the cryopreservation of gonadal tissue. At present the tissue can become functional only after re-transplantation, which might be undesirable by transgender individuals in the future. Preconception counseling, prenatal surveillance, perinatal support, contraceptive, and pregnancy termination related healthcare need to be meaningfully adapted for this patient population, and many knowledge gaps remain. Discussion Specialized FP reproductive healthcare for transgender and gender diverse individuals is in early evolution. Research should be conducted to examine effects of medical interventions on fertility, timing of FP, gamete preservation and outcome of the fertility treatments. Strategies to inform and educate transgender and gender diverse patients can lead to optimization of reproductive care and counseling and decision making of FP for this population.
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Affiliation(s)
- Kenny Rodriguez-Wallberg
- Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pahology, Karolinska Institutet, Stockholm, Sweden
- Laboratory of Translational Fertility Preservation, NKS, Stockholm, Sweden
| | - Juno Obedin-Maliver
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Bernard Taylor
- Department of Obstetrics and Gynecology, Atrium Health, Charlotte, NC, USA
| | - Norah Van Mello
- Department of Obstetrics and Gynecology and Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Kelly Tilleman
- Department for Reproductive Medicine, Ghent University Hospital, Ghent, Belgium
| | - Leena Nahata
- Center for Biobehavioral Health, The Abigail Wexner Research Institute, Columbus, OH, USA
- Division of Pediatric Endocrinology, Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
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Boguszewski KE, Woods S, Ducar DM, Taylor JF. Transgender and Gender Diverse Fertility Choices: Supporting the Decision-Making Process for Adolescents and Young Adults. J Pediatr 2022; 240:256-264.e1. [PMID: 34717962 DOI: 10.1016/j.jpeds.2021.10.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 10/01/2021] [Accepted: 10/14/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To qualitatively examine the fertility-related decision making process of transgender and gender diverse (TGD) adolescents and young adults (AYAs) and their parents, in the setting of pursing gender affirming treatments. STUDY DESIGN Twenty-five TGD AYAs and 6 parents of TGD AYAs participated in a focus group or individual semistructured interviews focused on participants' experience learning about the effects of gender affirming treatments on fertility as well as the process of making a fertility preservation decision. Using open coding, data were analyzed in an iterative process identifying emerging themes and relationships. A decisional satisfaction score was collected and/or coded for each participant. RESULTS Four broad themes related to the decision-making process were identified: (1) Critical steps include awareness, gathering information, and conversations; (2) External constraints limit choices; (3) Expanding the conversation beyond preservation; and (4) Emotional distress, conflict, and decisional satisfaction. Despite reporting emotional distress or conflict during the decision, TGD AYAs and parents of TGD AYAs generally reported a high level of satisfaction with their fertility preservation decision. CONCLUSIONS There are specific ways health care professionals and family members can support TGD AYAs in their fertility-related decision making process. Decisional satisfaction was common, regardless of whether TGD AYAs chose to pursue fertility preservation or not.
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Affiliation(s)
| | - Sarah Woods
- SUNY Upstate Medical University, Syracuse, NY
| | - Dallas M Ducar
- Transhealth Northampton, Northampton, MA; Department of Family, Community and Mental Health Systems, University of Virginia School of Nursing, Charlottesville, VA; Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA; College of Science, Northeastern Univeristy, Boston, MA; School of Nursing, Columbia University, New York, NY
| | - Julia F Taylor
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA
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30
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de Nie I, Mulder CL, Meißner A, Schut Y, Holleman EM, van der Sluis WB, Hannema SE, den Heijer M, Huirne J, van Pelt AMM, van Mello NM. Histological study on the influence of puberty suppression and hormonal treatment on developing germ cells in transgender women. Hum Reprod 2021; 37:297-308. [PMID: 34791270 PMCID: PMC8804334 DOI: 10.1093/humrep/deab240] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 10/04/2021] [Accepted: 10/21/2021] [Indexed: 11/30/2022] Open
Abstract
STUDY QUESTION Can transgender women cryopreserve germ cells obtained from their orchiectomy specimen for fertility preservation, after having used puberty suppression and/or hormonal treatment? SUMMARY ANSWER In the vast majority of transgender women, there were still immature germ cells present in the orchiectomy specimen, and in 4.7% of transgender women—who all initiated medical treatment in Tanner stage 4 or higher—mature spermatozoa were found, which would enable cryopreservation of spermatozoa or testicular tissue after having used puberty suppression and/or hormonal treatment. WHAT IS KNOWN ALREADY Gender affirming treatment (i.e. puberty suppression, hormonal treatment, and subsequent orchiectomy) impairs reproductive function in transgender women. Although semen cryopreservation is generally offered during the transition process, this option is not feasible for all transgender women (e.g. due to incomplete spermatogenesis when initiating treatment in early puberty, in case of inability to masturbate, or when temporary cessation of hormonal treatment is too disruptive). Harvesting mature spermatozoa, or testicular tissue harboring immature germ cells, from orchiectomy specimens obtained during genital gender-affirming surgery (gGAS) might give this group a chance of having biological children later in life. Previous studies on spermatogenesis in orchiectomy specimens showed conflicting results, ranging from complete absence of germ cells to full spermatogenesis, and did not involve transgender women who initiated medical treatment in early- or late puberty. STUDY DESIGN, SIZE, DURATION Histological and immunohistochemical analyses were performed on orchiectomy specimens from 214 transgender women who underwent gGAS between 2006 and 2018. Six subgroups were identified, depending on pubertal stage at initiation of medical treatment (Tanner stage 2-3, Tanner stage 4-5, adult), and whether hormonal treatment was continued or temporarily stopped prior to gGAS in each of these groups. PARTICIPANTS/MATERIALS, SETTING, METHODS All transgender women used a combination of estrogens and testosterone suppressing therapy. Orchiectomy specimen sections were stained with Mayer’s hematoxylin and eosin and histologically analyzed to assess the Johnsen score and the ratio of most advanced germ cell types in at least 50 seminiferous tubular cross-sections. Subsequently, immunohistochemistry was used to validate these findings using spermatogonia, spermatocytes or spermatids markers (MAGE-A3/A4, γH2AX, Acrosin, respectively). Possibilities for fertility preservation were defined as: preservation of spermatozoa, preservation of spermatogonial stem cells or no possibilities (in case no germ cells were found). Outcomes were compared between subgroups and logistic regression analyses were used to assess the association between the duration of hormonal treatment and the possibilities for fertility preservation. MAIN RESULTS AND THE ROLE OF CHANCE Mature spermatozoa were encountered in 4.7% of orchiectomy specimens, all from transgender women who had initiated medical treatment in Tanner stage 4 or higher. In 88.3% of the study sample orchiectomy specimens only contained immature germ cells (round spermatids, spermatocytes or spermatogonia, as most advanced germ cell type). In 7.0%, a complete absence of germ cells was observed, all these samples were from transgender women who had initiated medical treatment in adulthood. Cessation of hormonal treatment prior to gGAS did not affect the presence of germ cells or their maturation stage, nor was there an effect of the duration of hormonal treatment prior to gGAS. LIMITATIONS, REASONS FOR CAUTION Since data on serum hormone levels on the day of gGAS were not available, we were unable to verify if the transgender women who were asked to temporarily stop hormonal treatment 4 weeks prior to surgery actually did so, and if people with full spermatogenesis were compliant to treatment. WIDER IMPLICATIONS OF THE FINDINGS There may still be options for fertility preservation in orchiectomy specimens obtained during gGAS since a small percentage of transgender women had full spermatogenesis, which could enable cryopreservation of mature spermatozoa via a testicular sperm extraction procedure. Furthermore, the vast majority still had immature germ cells, which could enable cryopreservation of testicular tissue harboring spermatogonial stem cells. If maturation techniques like in vitro spermatogenesis become available in the future, harvesting germ cells from orchiectomy specimens might be a promising option for those who are otherwise unable to have biological children. STUDY FUNDING/COMPETING INTEREST None. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- I de Nie
- Department of Endocrinology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Center of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Obstetrics and Gynecology, Amsterdam UMC, Amsterdam Reproduction & Development Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - C L Mulder
- Reproductive Biology Laboratory, Center for Reproductive Medicine, Amsterdam UMC, Amsterdam Reproduction & Development Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - A Meißner
- Department of Endocrinology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Center of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Obstetrics and Gynecology, Amsterdam UMC, Amsterdam Reproduction & Development Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Y Schut
- Reproductive Biology Laboratory, Center for Reproductive Medicine, Amsterdam UMC, Amsterdam Reproduction & Development Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - E M Holleman
- Reproductive Biology Laboratory, Center for Reproductive Medicine, Amsterdam UMC, Amsterdam Reproduction & Development Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - W B van der Sluis
- Center of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - S E Hannema
- Center of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Pediatrics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M den Heijer
- Department of Endocrinology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Center of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - J Huirne
- Department of Obstetrics and Gynecology, Amsterdam UMC, Amsterdam Reproduction & Development Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - A M M van Pelt
- Reproductive Biology Laboratory, Center for Reproductive Medicine, Amsterdam UMC, Amsterdam Reproduction & Development Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - N M van Mello
- Center of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Obstetrics and Gynecology, Amsterdam UMC, Amsterdam Reproduction & Development Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Quinn GP, Tishelman AC, Chen D, Nahata L. Reproductive health risks and clinician practices with gender diverse adolescents and young adults. Andrology 2021; 9:1689-1697. [PMID: 33942552 PMCID: PMC8566321 DOI: 10.1111/andr.13026] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Reproductive health counseling is essential for adolescents and young adults (AYAs). Transgender and gender diverse (TGD) AYAs would benefit from tailored counseling given concerns about iatrogenic infertility and sexual dysfunction, and high rates of interpersonal violence, unplanned pregnancies and sexually transmitted infections, yet there are multiple obstacles to providing this care at the patient/family and clinician levels. OBJECTIVES This narrative review summarizes the literature on reproductive health considerations for TGD AYAs, current practices, and clinician barriers and facilitators to providing culturally sensitive reproductive care for TGD AYAs. Specific areas of focus include reproductive health goals, risks, and access barriers; clinician knowledge practices and challenges; and strategies for improving counseling practices. MATERIALS AND METHODS PubMed, Google Scholar, Medline, Web of Science, and PsycInfo databases were searched using the following terms: transgender, non-binary, gender expansive, gender non-conforming, reproductive health, sexual health, fertility, family planning/building, contraception, sexual dysfunction; gender-affirming hormones/surgery, clinician, physician or provider knowledge and attitudes; counseling. RESULTS Many TGD AYAs desire biological children and improved sexual experiences. TGD AYAs may experience infertility and sexual dysfunction associated with transition; have disproportionate HIV/STI risk; experience high rates of interpersonal/sexual violence and trauma; and encounter barriers to accessing competent medical care. Clinicians lack knowledge about reproductive health needs of TGD AYAs; inconsistently discuss family building options; perceive counseling challenges; and desire more training in this area. DISCUSSION Enriched communication training for medical/mental health clinicians is necessary to provide a skilled workforce for TGD AYAs. Web-based reproductive health training with other populations (eg oncology) demonstrates efficacy for improving communication skills and confidence in counseling, CONCLUSION: This review highlights barriers to adequate reproductive care encountered by TGD AYAs, exacerbated in underserved minority youth. Dedicated training for providers, and programs increasing access are important goals for improving care. The need for additional research is also emphasized.
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Affiliation(s)
- Gwendolyn P. Quinn
- Grossman School of Medicine, Departments of OB-GYN and Population Health, NY, NY, USA
| | - Amy C. Tishelman
- Boston Children’s Hospital, Departments of Psychiatry and Endocrinology, Boston, MA, USA
- Harvard Medical School, Departments of Psychiatry and Endocrinology, Boston, MA, USA
| | - Diane Chen
- Potocsnak Family Division of Adolescent and Young Adult Medicine, and Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
- Departments of Psychiatry and Behavioral Sciences, and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Leena Nahata
- Department of Pediatrics, The Ohio State University College of Medicine; Section of Endocrinology, Nationwide Children’s Hospital, Columbus, OH, USA
- Center for Biobehavioral Health, Abigail Wexner Research Institute, Columbus, OH, USA
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32
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Alur-Gupta S, Vu M, Vitek W. Adolescent Fertility Preservation: Where Do We Stand Now. Semin Reprod Med 2021; 40:69-78. [PMID: 34687030 DOI: 10.1055/s-0041-1735891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Adolescence is a period of flux for many body systems. While fertility potential typically increases after menarche, there are diseases where the opposite occurs and fertility preservation options need to be considered early. In cases of cancer, options vary by pubertal status and can include ovarian tissue cryopreservation, oocyte cryopreservation, sperm cryopreservation, and testicular tissue cryopreservation. Much remains to be learned about fertility and preservation options in those with differences in sexual development (DSDs); however, depending on the form of DSD, fertility preservation may not be necessary. Similarly, traditional fertility counseling in children with galactosemia may need to be changed, as data suggest that fertility rates attributed to other causes of premature ovarian insufficiency may not be as applicable to this disease. Adolescents with Turner's syndrome are at high risk for premature ovarian failure; therefore, it is important to consider options as early as possible since ovarian reserves are depleted quickly. On the other hand, transgender and gender diverse adolescents may even be able to undergo fertility preservation after starting hormone therapy. In all cases, there are additional ethical components including technical/surgical risks in childhood, offering experimental therapies without creating false hope and evaluating children's consent and assent capabilities that must be considered.
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Affiliation(s)
- Snigdha Alur-Gupta
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York
| | - Michelle Vu
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York
| | - Wendy Vitek
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York
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Bonan S, Chapel-Lardic E, Rosenblum O, Dudkiewicz-Sibony C, Chamouard L, Wolf JP, Thiounn N, Condat A, Chalas C, Patrat C, Mendes N, Drouineaud V. Characteristics and intentions of heterosexual couples comprising a transgender man awaiting sperm donation to conceive a child. Andrology 2021; 9:1799-1807. [PMID: 34467677 DOI: 10.1111/andr.13103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 08/08/2021] [Accepted: 08/13/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND More than half of transgender (TG) men wish to have children. Until recently, TG people in France were rarely offered gamete donation, mainly because the Bioethics Law allows the use of assisted reproductive technologies (ART) only in infertile couples. The only option currently available for heterosexual couples with a TG man is ART with sperm donation. The Center for Study and Preservation of Eggs and Sperm (CECOS) of the Cochin Hospital is the first French center to propose sperm donation to such couples, and has done so since 1999. OBJECTIVES To determine the main characteristics and intentions of 43 couples, including a TG man and his cisgender female partner awaiting sperm donation. MATERIALS AND METHODS A retrospective analysis was carried out on the records from October 2010 to December 2019, of 43 couples with a TG man who applied for sperm donation at the CECOS of the Cochin Hospital (Paris, France). RESULTS The mean age of TG men and cisgender women was 32 ± 6.6 and 29.7 ± 4.6 years, respectively. In 77% of cases, the couple met before the man's transition. Eighty-one percent of the couples were in a stable relationship for at least 3 years, and 94% wished to have a child for no more than 5 years. Almost all of the couples (95%) intended to inform their child of their conception by sperm donation and the father's transidentity (92%). DISCUSSION Due to restrictive French legislation, the profile of our couples probably does not reflect that of all couples consisting of a TG man and a cisgender woman. The study took place over a long period of time and the characteristics of the couples could probably change over time. CONCLUSION The couples often met before the man's transition, cohabited for several years, intended to inform their child of sperm donation and the father's transidentity.
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Affiliation(s)
- Sarah Bonan
- Service de Biologie de la Reproduction - CECOS, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris (AP-HP) Centre, Université de Paris, Paris, France
| | - Emeline Chapel-Lardic
- Service de Biologie de la Reproduction - CECOS, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris (AP-HP) Centre, Université de Paris, Paris, France
| | - Ouriel Rosenblum
- Service de Biologie de la Reproduction - CECOS, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris (AP-HP) Centre, Université de Paris, Paris, France.,Service de Psychiatrie de l'enfant et de l'adolescent, Hôpital Universitaire La Pitié - Salpétrière, Assistance Publique - Hôpitaux de Paris (AP-HP), Sorbonne Université, Paris, France
| | - Charlotte Dudkiewicz-Sibony
- Service de Biologie de la Reproduction - CECOS, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris (AP-HP) Centre, Université de Paris, Paris, France
| | - Laura Chamouard
- Service de Biologie de la Reproduction - CECOS, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris (AP-HP) Centre, Université de Paris, Paris, France
| | - Jean-Philippe Wolf
- Service de Biologie de la Reproduction - CECOS, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris (AP-HP) Centre, Université de Paris, Paris, France.,Inserm U1016, Institut Cochin, Université de Paris, Paris, France
| | - Nicolas Thiounn
- Inserm U1016, Institut Cochin, Université de Paris, Paris, France.,Service d'Urologie, Centre Hospitalier Georges Pompidou, Assistance Publique - Hôpitaux de Paris (AP-HP) Centre, Université de Paris, Paris, France
| | - Agnès Condat
- Service de Psychiatrie de l'enfant et de l'adolescent, Hôpital Universitaire La Pitié - Salpétrière, Assistance Publique - Hôpitaux de Paris (AP-HP), Sorbonne Université, Paris, France
| | - Céline Chalas
- Service de Biologie de la Reproduction - CECOS, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris (AP-HP) Centre, Université de Paris, Paris, France
| | - Catherine Patrat
- Service de Biologie de la Reproduction - CECOS, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris (AP-HP) Centre, Université de Paris, Paris, France.,Inserm U1016, Institut Cochin, Université de Paris, Paris, France
| | - Nicolas Mendes
- Service de Psychiatrie de l'enfant et de l'adolescent, Hôpital Universitaire La Pitié - Salpétrière, Assistance Publique - Hôpitaux de Paris (AP-HP), Sorbonne Université, Paris, France
| | - Véronique Drouineaud
- Service de Biologie de la Reproduction - CECOS, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris (AP-HP) Centre, Université de Paris, Paris, France
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Schwartz AR, Moravek MB. Reproductive potential and fertility preservation in transgender and nonbinary individuals. Curr Opin Obstet Gynecol 2021; 33:327-334. [PMID: 34173770 DOI: 10.1097/gco.0000000000000729] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE OF REVIEW To synthesize recent literature to better understand parenting desires and challenges of transgender individuals as well as the impact of gender-affirming care on reproductive potential. RECENT FINDINGS Survey studies of transgender and nonbinary individuals demonstrate significant parenting interest, yet uptake in fertility preservation services remains low with potential for decisional regret. Masculinizing hormones have demonstrated variable effects on folliculogenesis and follicle distribution in the human ovary. In the mouse model, testosterone administration has demonstrated an increase in atretic late antral follicles without a reduction in primordial or total antral follicle counts and a preserved ability to respond to gonadotropin stimulation. Case series of transgender individuals undergoing oocyte or embryo cryopreservation are promising with outcomes similar to cisgender controls. Feminizing hormones have shown detrimental effects on sperm parameters at time of cryopreservation and spermatogenesis in orchiectomy samples with uncertainty regarding the reversibility of these changes. SUMMARY Current evidence demonstrates variable effects of gender-affirming hormones on ovarian and testicular function with potential for detrimental impact on an individual's reproductive potential. As many individuals initiate gender-affirming care prior to or during their reproductive years it is imperative that they receive thorough fertility preservation counseling and improved access to reproductive care services.
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Affiliation(s)
- Amanda R Schwartz
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
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35
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Eustache F, Drouineaud V, Mendes N, Delépine B, Dupont C, Mirallié S, Papaxanthos A, Metzler-Guillemain C, Rives-Feraille A, Magnan F, Grèze C, Hennebicq S, Koscinski I, Drapier H, Frapsauce C, Mayeur A, Carlotti MA, Mons J, Schmitt F, May-Panloup P, Blagosklonov O, Brugnon F, Mestres S, Cabry R, Fauque P, Loup-Cabaniols V, Ravel C, Lévy R, Patrat C, Thibault E, Frydman N, Bujan L, Morinière C, Ducrocq B, Rives N. Fertility preservation and sperm donation in transgender individuals: the current situation within the French CECOS network. Andrology 2021; 9:1790-1798. [PMID: 34236139 DOI: 10.1111/andr.13075] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/29/2021] [Accepted: 06/29/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Many studies reported that reproductive desire could be high among transgender (TG) individuals. In France, fertility preservation (FP) and sperm donation were very little proposed to TG individuals until recently, mainly because the Bioethics Law allows the use of Assisted Reproductive Technologies (ART) only in infertile couples and prohibits surrogacy. OBJECTIVES To evaluate the distribution of care on the French territory concerning fertility preservation and sperm donation in TG individuals. MATERIALS AND METHODS A multicentric national survey was carried out between January 2019 and October 2020 in 28 ART centres of the French CECOS (Centres d'Etudes et de Conservation des Oeufs et du Sperme) network. Each centre was questioned to find out how many TG individuals came, were informed and cared for FP and sperm donation. RESULTS Concerning FP, 71.4% of centres received TG individuals and performed gamete cryopreservation; 581 TG individuals consulted for FP. TG women were more likely to desire (P<0.0001) and achieve (P<0.0001) FP than TG men. Concerning sperm donation in couples including a TG man, 68% of centres offer the complete course from the first consultation to the completion of the ART cycles; 122 offspring has been conceived with sperm donation in couples including a TG man since 1999. DISCUSSION Our results showed that even if all centres do not propose FP or sperm donation in TG individuals, these ART are present throughout the French territory. The major point is that both FP and sperm donation in TG individuals have grown significantly and that the care of these patients is improving year after year. CONCLUSION In France, most of CECOS centres can take care of TG individuals for FP and sperm donation. The French Bioethics law allows these latter, and TG individuals can benefit from a financial support of the national health care insurance for FP and sperm donation. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Florence Eustache
- Service D'Histologie-Embryologie, Cytogénétique, Biologie de La Reproduction / CECOS, Hôpitaux Universitaires Paris Seine-Saint-Denis, Site Jean Verdier, Bondy, France
| | - Véronique Drouineaud
- Service de Biologie de la Reproduction-CECOS, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP). Centre, Université de Paris, Paris, 75014, France
| | - Nicolas Mendes
- Service D'Histologie-Embryologie, Cytogénétique, Biologie de La Reproduction / CECOS, Hôpitaux Universitaires Paris Seine-Saint-Denis, Site Jean Verdier, Bondy, France
| | - Béatrice Delépine
- CECOS Champagne-Ardenne, Chu de Reims Hôpital d'Enfants, REIMS, Cedex, 51092, France
| | | | - Sophie Mirallié
- CECOS Pays de la Loire Nantes Service de Biologie de la reproduction, Nantes, Cedex 1, 44093, France
| | - Aline Papaxanthos
- CECOS Aquitaine, BORDEAUX Maternité CHU Pellegrin, Bordeaux, 33076, France
| | | | - Aurélie Rives-Feraille
- Normandie Univ, UNIROUEN, EA 4308 "Gametogenesis and Gamete Quality", Rouen University Hospital, Biology of Reproduction-CECOS Laboratory, Rouen, 76031, France
| | - Fanny Magnan
- Service D'Histologie-Embryologie, Cytogénétique, Biologie de La Reproduction / CECOS, Hôpitaux Universitaires Paris Seine-Saint-Denis, Site Jean Verdier, Bondy, France
| | - Cécile Grèze
- CECOS Alsace, STRASBOURG CMCO, Schiltighem, 67303, France
| | - Sylviane Hennebicq
- CECOS Rhône Alpes, GRENOBLE Hôpital Couple Enfant CHU GRENOBLE CEDEX 9, Cedex, France
| | - Isabelle Koscinski
- CECOS Lorraine Nancy, Maternité régionale Universitaire, Nancy, 54042, France
| | - Hortense Drapier
- Biologie de la Reproduction-CECOS, Hôpital de La Cavale Blanche, Brest, 29200, France
| | - Cynthia Frapsauce
- Service de Médecine et Biologie de la Reproduction-CECOS, CHRU Bretonneau, Tours, 37000, France
| | - Anne Mayeur
- CECOS Paris BECLERE, Hôpital Antoine Béclère, CLAMART, Cedex, 92140, France
| | | | - Joffrey Mons
- CECOS Océan Indien LA REUNION Centre, d'AMP CHU de La Réunion Saint- Pierre, Cedex, 97448, France
| | - Françoise Schmitt
- CECOS ALSACE Mulhouse Groupe Hospitalier, de la Région de Mulhouse et Sud Alsace, MULHOUSE, Cedex, 68070, France
| | - Pascale May-Panloup
- CECOS Pays de Loire, Antenne Angers, Laboratoire de Biologie de la Reproduction, Angers University Hospital, Angers, 49000, France
| | - Oxana Blagosklonov
- Service de Biologie et Médecine, de la Reproduction-Cryobiologie, CECOS CHRU Jean Minjoz, Besancon, 25030, France
| | - Florence Brugnon
- CECOS Auvergne, Clermont FERRAND CHU Estaing, CLERMONT FERRAND CEDEX 1, Clermont, 63003, France
| | - Stéphanie Mestres
- CECOS Auvergne, Clermont FERRAND CHU Estaing, CLERMONT FERRAND CEDEX 1, Clermont, 63003, France
| | | | | | - Vanessa Loup-Cabaniols
- CECOS Languedoc Roussillon, MONTPELLIER Hôpital Arnaud de Villeneuve, Montpellier, 34295, France
| | - Célia Ravel
- CECOS Bretagne, RENNES Hôpital Sud, Rennes, 35200, France
| | - Rachel Lévy
- CECOS Paris TENON Hôpital, Tenon, Paris, 75020, France
| | - Catherine Patrat
- Service de Biologie de la Reproduction-CECOS, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP). Centre, Université de Paris, Paris, 75014, France
| | - Emmanuelle Thibault
- CECOS Provence Alpes, Côte d'Azur NICE Centre de reproduction CHU de NICE, Nice, 06202, France
| | - Nelly Frydman
- CECOS Paris BECLERE, Hôpital Antoine Béclère, CLAMART, Cedex, 92140, France
| | - Louis Bujan
- CECOS Midi Pyrénées, TOULOUSE Hôpital Paule de Viguier, Toulouse, 31059, France
| | | | - Bérengère Ducrocq
- CECOS Nord LILLE CHRU, de LILLE Hôpital Calmette Lille, Cedex, 59037, France
| | - Nathalie Rives
- Normandie Univ, UNIROUEN, EA 4308 "Gametogenesis and Gamete Quality", Rouen University Hospital, Biology of Reproduction-CECOS Laboratory, Rouen, 76031, France
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Birenbaum-Carmeli D, Inhorn MC, Patrizio P. Transgender men's fertility preservation: experiences, social support, and the quest for genetic parenthood. CULTURE, HEALTH & SEXUALITY 2021; 23:945-960. [PMID: 32484394 DOI: 10.1080/13691058.2020.1743881] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 03/13/2020] [Indexed: 05/25/2023]
Abstract
Transgender people assigned female at birth may undergo fertility preservation by egg or embryo freezing, usually prior to gender affirming treatment. In this binational ethnographic study, four transgender men were included as part of a larger comparative project on fertility preservation. In-depth ethnographic interviews allowed informants to talk freely about their fertility preservation experiences, and the circumstances that had enabled them to pursue this option. Prominent in men's accounts were the importance of genetic parenthood and the role of social support from others in the fertility preservation process. Indeed, in all cases, social support-from parents, siblings, partners, peers, physicians and employers-was critical, effectively enabling young transgender men to embark on their fertility preservation journeys and undergo the physically taxing process. This study illustrates the power of thriving through relationships that were critical in young transgender men's experiences of fertility preservation.
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Affiliation(s)
| | - Marcia C Inhorn
- Department of Anthropology, Yale University, New Haven, CT, USA
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Kerman HM, Pham A, Crouch JM, Albertson K, Salehi P, Inwards-Breland DJ, Ahrens KR. Gender Diverse Youth on Fertility and Future Family: A Qualitative Analysis. J Adolesc Health 2021; 68:1112-1120. [PMID: 33712381 DOI: 10.1016/j.jadohealth.2021.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/01/2020] [Accepted: 01/03/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE Gender-affirming treatment for transgender and nonbinary adolescents has been shown to decrease anxiety, depression, and suicidality, but treatments have medical consequences. Specifically, hormone replacement and pubertal blocking may impact patients' fertility and childbearing capabilities. We interviewed gender diverse adolescents regarding their thoughts on family and fertility. METHODS We completed semistructured interviews with 23 gender diverse adolescents recruited from the Seattle Children's Gender Clinic. Interviewees included transfeminine, transmasculine, and nonbinary youth. Interviews were recorded, transcribed, and analyzed using Braun and Clarke's theory of thematic analysis, a flexible framework for qualitative analysis. RESULTS Gender diverse adolescents have myriad views on fertility, but four main themes were identified: (1) an interest in future family, including ideas regarding adoption and biological children; (2) barriers to fertility, including cost and procedure-related dysphoria; (3) factors unique to the developmental stage of adolescents, including the age discordance of making fertility decisions as a teenager and parental influence on decision-making; and (4) suggestions for clinicians approaching fertility counseling with adolescents considering hormone therapy. CONCLUSIONS Many gender diverse youth asserted an interest in building families, although the process of fertility preservation remains fraught. Relative to other studies, our participants were hopeful, imaginative, and interested in having children. Participants wanted to receive specific counseling on fertility, to receive help navigating the logistics of fertility preservation, and to be listened to when their hopes for children (or no children) were stated. Further research is needed to create care paradigms that address fertility of transgender youth in an affirming, developmentally appropriate manner.
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Affiliation(s)
- Hannah M Kerman
- Warren Alpert Medical School of Brown University, Providence, Rhode Island.
| | - An Pham
- Seattle Children's Research Institute, Seattle, Washington
| | - Julia M Crouch
- Warren Alpert Medical School of Brown University, Providence, Rhode Island; Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington
| | | | - Parisa Salehi
- Seattle Children's Research Institute, Seattle, Washington; University of Washington, Seattle, Washington; Division of Endocrinology, Seattle Children's Hospital, Seattle, Washington
| | - David J Inwards-Breland
- Division of Adolescent and Young Adult Medicine, Rady Children's Hospital, San Diego, California; University of California, San Diego School of Medicine, La Jolla, California
| | - Kym R Ahrens
- Seattle Children's Research Institute, Seattle, Washington; Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington; University of Washington, Seattle, Washington
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Lai TC, Davies C, Robinson K, Feldman D, Elder CV, Cooper C, Pang KC, McDougall R. Effective fertility counselling for transgender adolescents: a qualitative study of clinician attitudes and practices. BMJ Open 2021; 11:e043237. [PMID: 34011585 PMCID: PMC8137211 DOI: 10.1136/bmjopen-2020-043237] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Fertility counselling for trans and gender diverse (TGD) adolescents has many complexities, but there is currently little guidance for clinicians working in this area. This study aimed to identify effective strategies for-and qualities of-fertility counselling for TGD adolescents based on clinicians' experiences. DESIGN We conducted qualitative semi-structured individual interviews in 2019 which explored clinician experiences and fertility counselling practices, perspectives of the young person's experience and barriers and facilitators to fertility preservation access. Data were analysed using thematic analysis. SETTING This qualitative study examined experiences of clinicians at the Royal Children's Hospital-a tertiary, hospital-based, referral centre and the main provider of paediatric TGD healthcare in Victoria, Australia. PARTICIPANTS We interviewed 12 clinicians from a range of disciplines (paediatrics, psychology, psychiatry and gynaecology), all of whom were involved with fertility counselling for TGD adolescents. RESULTS Based on clinician experiences, we identified five elements that can contribute to an effective approach for fertility counselling for TGD adolescents: a multidisciplinary team approach; shared decision-making between adolescents, their parents and clinicians; specific efforts to facilitate patient engagement; flexible personalised care; and reflective practice. CONCLUSIONS Identification of these different elements can inform and hopefully improve future fertility counselling practices for TGD adolescents, but further studies examining TGD adolescents' experiences of fertility counselling are also required.
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Affiliation(s)
- Timothy Chwan Lai
- Austin Health, Heidelberg, Victoria, Australia
- The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Cristyn Davies
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kerry Robinson
- School of Social Sciences, Western Sydney University, Kingswood, New South Wales, Australia
| | - Debi Feldman
- The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Charlotte Victoria Elder
- Austin Health, Heidelberg, Victoria, Australia
- The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Mercy Hospital for Women, Heidelberg, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Charlie Cooper
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Ken C Pang
- The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Rosalind McDougall
- The University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
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Call DC, Challa M, Telingator CJ. Providing Affirmative Care to Transgender and Gender Diverse Youth: Disparities, Interventions, and Outcomes. Curr Psychiatry Rep 2021; 23:33. [PMID: 33851310 DOI: 10.1007/s11920-021-01245-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW This paper reviews the evolving body of research on the mental health of transgender and gender diverse (TGD) youth. Minority stress experiences in families, schools, and the community impact the health and well-being of this population due to experiences of stigma, discrimination, and rejection. Poor healthcare access and outcomes may be compounded in youth with intersectional identities. RECENT FINDINGS There is increasing evidence that gender-affirming interventions improve mental health outcomes for TGD youth. TGD youth report worse mental health outcomes in invalidating school and family environments and improved outcomes in affirming climates. TGD youth experience significant healthcare disparities, and intersectional clinical approaches are needed to increase access to affirmative care. Providers can best support TGD youth by considering ways they can affirm these youth in their healthcare settings, and helping them access support in schools, family systems, and communities. Understanding the intersection of multiple minority identities can help providers address potential barriers to care to mitigate the health disparities seen in this population.
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Affiliation(s)
- David C Call
- Department of Psychiatry and Behavioral Sciences, Children's National Hospital, Washington, DC, USA
| | - Mamatha Challa
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Cynthia J Telingator
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA, USA. .,Harvard Medical School, Boston, MA, USA.
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Stark B, Nagle SA, Hunter A, Charlton BM, Katz-Wise SL. Family building desires among transgender and gender expansive adolescents: A longitudinal family-level analysis. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2021; 22:425-439. [PMID: 37808529 PMCID: PMC10553371 DOI: 10.1080/26895269.2021.1896410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Introduction Professional societies state that Transgender and gender expansive (TGE) adolescents and their families should be counseled about future family building options prior to initiating gender affirming therapy. While emerging data show that TGE adolescents have diverse desires regarding future family building, little is known regarding how these preferences are developed in a larger ecological context. Aim The current study used Ecological Systems Theory as a framework to describe the family building attitudes of TGE adolescents, their caregivers, and their siblings. Methods Participants were recruited from community-based venues in the New England region of the U.S. to participate in the TTFN Project, a longitudinal community-based mixed methods study. The sample for the current study included 84 family members from 30 families (30 TGE adolescents, 11 siblings, 44 caregivers). All participants completed a semi-structured qualitative interview about family building attitudes and desires for TGE and cisgender adolescents at two waves across 6-8 months. Interview transcripts were analyzed using a combination of immersion/crystallization, thematic analysis, and template organizing style approaches. The Transgender Youth Fertility Attitudes Questionnaire (TYFAQ) was employed to quantitatively describe the family building attitudes of TGE adolescents and their families. Results Eight themes corresponding to the levels of the ecological systems model - individual-level (perceived reproductive potential, reproductive identity), family-level (communication about family building, familial experiences and expectations), community-level (community support and role models; community expectations and norms), and societal/institutional-level (medicalization of family building, external sociopolitical factors) - were developed from the interviews. Results from the TYFAQ indicated that compared to cisgender adolescents, TGE adolescents were less likely to value having biological children and more likely to consider adoption in comparison to their cisgender siblings. Discussion Findings emphasize the importance of using Ecological Systems Theory to understand the family building attitudes and desires of TGE adolescents and their families.
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Affiliation(s)
- Brett Stark
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Shea A. Nagle
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Adam Hunter
- Department of Health Policy, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Brittany M. Charlton
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Sabra L. Katz-Wise
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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Quain KM, Kyweluk MA, Sajwani A, Gruschow S, Finlayson C, Gordon EJ, Johnson EK, Persky R, Dowshen N, Chen D. Timing and Delivery of Fertility Preservation Information to Transgender Adolescents, Young Adults, and Their Parents. J Adolesc Health 2021; 68:619-622. [PMID: 32826153 PMCID: PMC8522212 DOI: 10.1016/j.jadohealth.2020.06.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 06/16/2020] [Accepted: 06/25/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE This study aimed to examine transgender adolescents and young adults' (AYA) and their parents' preferences regarding fertility preservation (FP) information provision and discussion timing. METHODS Data were derived from two separate studies: an online survey and semistructured qualitative interviews. Survey data were analyzed using descriptive statistics and interview data using conventional content analysis. RESULTS Survey participants (AYA: 88% and parents: 93%) preferred gender clinic physicians provide FP information, and nearly one-third endorsed mental health professionals (AYA: 28% and parents: 26%) or fertility specialists (AYA: 23% and parents: 30%). Interview participants' FP discussion timing preferences ranged from the initial clinic visit, follow-up visits, before medical intervention, to mentioning FP early but deferring in-depth discussion to follow-up visits. CONCLUSIONS Gender clinic physicians, mental health professionals, and fertility specialists should be prepared to discuss FP with transgender AYA and their parents. Opinions varied regarding when to provide FP information; therefore, discussion timing may need to be individualized.
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Affiliation(s)
- Kit M Quain
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania; Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
| | - Moira A Kyweluk
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Afiya Sajwani
- Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Siobhan Gruschow
- Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Courtney Finlayson
- Division of Pediatric Endocrinology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Elisa J Gordon
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Emilie K Johnson
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Rebecca Persky
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Nadia Dowshen
- Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Diane Chen
- Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Psychiatric and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Katabi LJ, Ng HH, Streed CG, Arora KS. Ethical Considerations of Fertility Preservation for Transmasculine and Nonbinary Youth. Transgend Health 2020; 5:201-204. [PMID: 33381649 DOI: 10.1089/trgh.2020.0004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
An increasing number of young adolescents who identify as transgender or nonbinary are presenting to the health care system for gender affirmation therapy before the full progression of puberty. Gender-affirming therapy may impair future fertility, but options exist for fertility preservation. This perspective reviews these options for transmasculine and nonbinary youth, and explores related ethical considerations. The authors support the right of transgender and nonbinary youth to utilize available reproductive technologies, provide recommendations for treating health professionals, and advocate for increased research efforts and tools to aid patient decision making.
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Affiliation(s)
- Leila J Katabi
- Department of Bioethics, Case Western Reserve University, Cleveland, Ohio, USA.,School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Henry H Ng
- Center for LGBT Health, Cleveland Clinic Foundation, Cleveland, Ohio, USA.,Public Health and Science Department, Baldwin Wallace University, Berea, Ohio, USA
| | - Carl G Streed
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA.,Center for Transgender Medicine and Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Kavita S Arora
- Department of Bioethics, Case Western Reserve University, Cleveland, Ohio, USA.,Department of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, Ohio, USA
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Langer MD, Silver EJ, Dodson NA, Talib HJ, Coupey SM. Fertility Desires of Adolescent Females: Decreased Desire for Children in Those Identifying as Transgender/Gender Diverse and in Depressed Adolescents. J Pediatr Adolesc Gynecol 2020; 33:703-707. [PMID: 32927031 PMCID: PMC7486297 DOI: 10.1016/j.jpag.2020.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/31/2020] [Accepted: 09/04/2020] [Indexed: 12/18/2022]
Abstract
STUDY OBJECTIVE We aimed to describe fertility desires in healthy adolescent females and to explore associations of fertility desire with conditions and therapies potentially compromising fertility. DESIGN This was a cross-sectional, anonymous survey. SETTING AND PARTICIPANTS A total of 323 female adolescents aged 13-19 years were recruited from clinic waiting areas at a children's hospital. We oversampled on days when clinics serving adolescents with potential fertility compromise were scheduled. MAIN OUTCOME MEASURES We measured fertility desire by agreement with the statement "I want to have children someday." To measure compromised fertility we asked "In the past year, has a doctor, nurse or other medical professional ever talked to you about the possibility that you may have decreased fertility and may not be able to have your own biological child someday?" To measure depression severity, we used a validated scale, the PHQ-9, scores were dichotomized into no/mild and moderate/severe depression. RESULTS Mean age was 16.06 ± 1.87 years. Of the 323 participants, 57% identified as Hispanic, 24% as Black, 93.5% as cisgender, 6.5% as transgender/gender diverse, 70% as heterosexual, and 30% as sexual minority. A total of 35% had moderate/severe depression, and 12% had compromised fertility. Overall, 89% wanted children. Fewer transgender/gender diverse than cisgender participants wanted children (67% vs 93%, P < .001), as did fewer with moderate/severe versus no/mild depression (83% vs 93%, P < .05), whereas those with compromised fertility versus those without and heterosexual versus sexual minority participants had similar fertility desires. Transgender/gender diverse identity (odds ratio, 0.33; 95% confidence interval, 0.11-0.97; P < .05) and moderate/severe depression (odds ratio, 0.45; 95% confidence interval, 0.22-0.93; P < .05) were independently associated with lower fertility desire. CONCLUSIONS We found a high overall proportion of female adolescents desiring future children, and only 2 independent predictors of decreased fertility desire, namely, transgender/gender diverse identity and moderate/severe depression.
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Affiliation(s)
- Miriam D Langer
- Division of Adolescent Medicine, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY
| | - Ellen J Silver
- Division of Academic General Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY
| | - Nancy A Dodson
- Division of Adolescent Medicine, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY
| | - Hina J Talib
- Division of Adolescent Medicine, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY
| | - Susan M Coupey
- Division of Adolescent Medicine, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY.
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Persky RW, Gruschow SM, Sinaii N, Carlson C, Ginsberg JP, Dowshen NL. Attitudes Toward Fertility Preservation Among Transgender Youth and Their Parents. J Adolesc Health 2020; 67:583-589. [PMID: 32359942 PMCID: PMC7508908 DOI: 10.1016/j.jadohealth.2020.02.027] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 01/22/2020] [Accepted: 02/26/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE While gender-affirming hormones (GAH) may impact the fertility of transgender and gender diverse (TGGD) youth, few pursue fertility preservation (FP). The objective of this study is to understand youth and parent attitudes toward FP decision-making. METHODS This study is a cross-sectional survey of youth and parents in a pediatric, hospital-based gender clinic from April to December 2017. Surveys were administered electronically, containing 34 items for youth and 31 items for parents regarding desire for biological children, willingness to delay GAH for FP, and factors influencing FP decisions. RESULTS The mean age of youth (n = 64) was 16.8 years, and 64% assigned female at birth; 46 parents participated. Few youth (20%) and parents (13%) found it important to have biological children or grandchildren, and 3% of youth and 33% of parents would be willing to delay GAH for FP. The most common factor influencing youth FP decision-making was discomfort with a body part they do not identify with (69%), and for the parents, whether it was important to their child (61%). In paired analyses, youth and their parents answered similarly regarding youth desire for biological children and willingness to delay GAH for FP. CONCLUSIONS The majority of TGGD youth and parents did not find having biological offspring important and were not willing to delay GAH for FP. Discomfort with reproductive anatomy was a major influencing factor for youth FP decision-making and their child's wishes was a major factor for parents. Future qualitative research is needed to understand TGGD youth and parent attitudes toward FP and to develop shared decision-making tools.
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Affiliation(s)
- Rebecca W Persky
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
| | - Siobhan M Gruschow
- Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ninet Sinaii
- Department of Biostatistics and Clinical Epidemiology, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Claire Carlson
- Cancer Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jill P Ginsberg
- Cancer Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nadia L Dowshen
- Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Mayhew AC, Gomez-Lobo V. Fertility Options for the Transgender and Gender Nonbinary Patient. J Clin Endocrinol Metab 2020; 105:5892794. [PMID: 32797184 PMCID: PMC7455280 DOI: 10.1210/clinem/dgaa529] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/10/2020] [Indexed: 12/14/2022]
Abstract
Comprehensive care for transgender and gender nonbinary patients has been a priority established by the World Professional Association for Transgender Health. Because pubertal suppression, gender-affirming hormone therapy, and antiandrogen therapy used alone or in combination during medical transition can affect gonadal function, understanding the effects these treatments have on fertility potential is important for practitioners caring for transgender and gender nonbinary patients. In this review, we outline the impacts of gender-affirming treatments on fertility potential and discuss the counseling and the treatment approach for fertility preservation and/or family building in transgender and gender nonbinary individuals.
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Affiliation(s)
- Allison C Mayhew
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
- Children’s National Medical Center, Washington, DC
| | - Veronica Gomez-Lobo
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
- Children’s National Medical Center, Washington, DC
- Correspondence and Reprint Requests: Veronica Gomez-Lobo, MD, National Institute of Child Health and Human Development, Children’s National Medical Center, Division of Pediatric and Adolescent Gynecology, 10 Central Dr, Bldg 10, Rm 8N248, Bethesda, MD 20892, USA. E-mail:
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Kolbuck VD, Sajwani A, Kyweluk MA, Finlayson C, Gordon EJ, Chen D. Formative development of a fertility decision aid for transgender adolescents and young adults: a multidisciplinary Delphi consensus study. J Assist Reprod Genet 2020; 37:2805-2816. [PMID: 32995972 DOI: 10.1007/s10815-020-01947-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/10/2020] [Indexed: 12/19/2022] Open
Abstract
PURPOSE No educational and decision support tools exist to aid transgender and non-binary (TNB) adolescents and young adults (AYA) in making decisions about fertility preservation in the context of initiating gender-affirming medical care that can impair fertility. This study identified critical content areas and learning objectives to include in a decision aid about fertility preservation targeted for TNB AYA. METHODS Delphi methodology was leveraged to engage 80 multidisciplinary experts in reproductive medicine and pediatric transgender health care in a two round consensus building procedure. Proposed content areas rated as "probably keep" or "definitely keep" by 75% of experts were retained. Proposed learning objectives reaching 75% agreement on ratings of importance and priority were also identified. RESULTS The Delphi procedure identified five priority content areas (Basic Reproduction; Gender-Affirming Medical Interventions: Impacts on Fertility; Established Fertility Preservation Options; Benefits and Risks of Established Fertility Preservation Procedures; Alternative Pathways to Parenting) and 25 learning objectives to prioritize in a fertility-related decision aid for TNB AYA. CONCLUSION A multidisciplinary panel of experts achieved agreement around content areas and learning objectives to incorporate into a decision aid about fertility preservation for TNB AYA.
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Affiliation(s)
- Victoria D Kolbuck
- Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 161B, Chicago, IL, 60611-2605, USA
| | - Afiya Sajwani
- Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 161B, Chicago, IL, 60611-2605, USA
| | - Moira A Kyweluk
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Courtney Finlayson
- Division of Endocrinology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Center for Health Services and Outcomes Research and Center for Bioethics and Medical Humanities, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Elisa J Gordon
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Diane Chen
- Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 161B, Chicago, IL, 60611-2605, USA. .,Center for Health Services and Outcomes Research and Center for Bioethics and Medical Humanities, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. .,Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA. .,Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Fertility preservation options for transgender and gender-nonconforming individuals. Curr Opin Obstet Gynecol 2020; 31:170-176. [PMID: 30870185 DOI: 10.1097/gco.0000000000000537] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To provide an overview of the current state of knowledge of fertility risks of gender-affirming therapy, review fertility preservation options for transgender individuals and ways to minimize gender dysphoria during fertility treatment, and identify gaps in knowledge. RECENT FINDINGS Recent studies have corroborated older data that gender-affirming hormone therapy creates histopathological changes in the gonads; however, the newer data suggests that some function of the gametes may be preserved. One study in transgender men reported successful in-vitro maturation of testosterone-exposed oocytes with normal spindle structures, and recent studies in transgender women reveal early spermatogenesis in estradiol-exposed testes and some recovery of semen parameters following cessation of hormones. Particular attention has recently been given to fertility preservation in transgender adolescents, revealing unmet informational needs in this population and very few are actually pursuing fertility preservation, even with counseling. SUMMARY There is currently a paucity of data on the fertility effects of gender-affirming hormones, necessitating fertility preservation counseling prior to initiation of therapy. Several modifications can be made to fertility preservation protocols and procedures to decrease gender dysphoria or distress in transgender individuals, but outcome data is still lacking. Achieving high-quality data collection will likely require cooperation across multiple institutions.
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Chen D, Kyweluk MA, Sajwani A, Gordon EJ, Johnson EK, Finlayson CA, Woodruff TK. Factors Affecting Fertility Decision-Making Among Transgender Adolescents and Young Adults. LGBT Health 2020; 6:107-115. [PMID: 30985275 DOI: 10.1089/lgbt.2018.0250] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE This study aimed to identify factors affecting transgender adolescents' and young adults' (AYA) decisions to pursue fertility preservation (FP). METHODS Participants completed a semistructured interview between December 2016 and June 2017 to inform improvements in fertility counseling and the development of a fertility decision aid targeted to transgender youth. Interviews included open-ended questions within the following domains: (1) gender-affirming medical care received, (2) knowledge of gender-affirming hormone effects on fertility and FP options, (3) FP decision-making, and (4) how, when, and what information AYA prefer to receive regarding FP. The interviews were analyzed thematically. RESULTS Eighteen transgender AYA (ages 15-24) participated (60% participation rate). The majority was White (61%) and assigned female at birth (67%). Half received specialized FP counseling (50%). Few of the transgender AYA pursued FP (33%). Five key themes reflecting factors affecting transgender AYA's FP decision-making were identified: (1) future parenthood desires, (2) individual experiences of gender dysphoria, (3) family values around biological parenthood, (4) financial considerations, and (5) fertility information provision. CONCLUSIONS Transgender AYA consider numerous factors in deciding whether to pursue FP. Although individual desires for and family values around biological parenthood influenced whether AYA pursued specialized FP counseling, individual experiences of gender dysphoria and costs of FP were barriers. AYA also identified shortcomings in fertility counseling with providers, highlighting the need to establish standardized counseling protocols and develop patient decision aids.
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Affiliation(s)
- Diane Chen
- 1 The Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,2 Department of Child and Adolescent Psychiatry, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,3 Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,4 Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Moira A Kyweluk
- 5 Department of Anthropology, Northwestern University, Chicago, Illinois.,6 Program in Public Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Afiya Sajwani
- 1 The Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Elisa J Gordon
- 7 Division of Transplantation, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,8 Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,9 Center for Bioethics and Medical Humanities, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Emilie K Johnson
- 8 Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,10 Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,11 Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Courtney A Finlayson
- 4 Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,12 Division of Endocrinology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Teresa K Woodruff
- 13 Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,14 Division of Reproductive Science in Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Ethical issues involving fertility preservation for transgender youth. J Assist Reprod Genet 2020; 37:2453-2462. [PMID: 32780317 DOI: 10.1007/s10815-020-01873-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 06/25/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To investigate ethical issues associated with fertility preservation (FP) in transgender youth based on reports of patients and their parents. METHODS Our qualitative study involved in-person interviews with 54 subjects (35 patients and 19 parents). Interviews were audio recorded, transcribed, and verified. Each subject completed a demographic questionnaire, and each patient's medical chart was reviewed for additional information. We analyzed the data using inductive thematic content analysis. RESULTS Themes that emerged included a range of desires and ambivalence about having genetically related children, variability in understanding the potentially irreversible impact of gender affirming hormones (GAHs) on fertility, use of adoption, and the impact of age on decision-making. Subjects (patients and parents) noted barriers to FP, such as cost and insurance coverage. Several parents expressed concern that their transgender children may have future regret about not attempting FP. Both transgender youth and their parents felt FP was an important precaution. CONCLUSIONS Our study took advantage of the richness of personal narratives to identify ongoing ethical issues associated with fertility preservation in transgender youth. Transgender youth and their parents did not fully understand the process of FP, especially regarding the effects of GAHs, had fears that FP could reactivate gender dysphoria, and noted barriers to FP, such as cost, highlighting economic disparity and lack of justice. These findings highlight ethical issues involving the adequacy of informed consent and economic injustice in access to FP despite expressed interest in the topic.
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Morrison A, Olezeski C, Cron J, Kallen AN. A Pilot Study to Assess Attitudes Toward Future Fertility and Parenthood in Transgender and Gender Expansive Adolescents. Transgend Health 2020. [DOI: 10.1089/trgh.2019.0075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Aimee Morrison
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
| | - Christy Olezeski
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Julia Cron
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
| | - Amanda N. Kallen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
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