1
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Razafintsalama M, Reignier A, Chaillot M, Freour T. [France's first birth after autologous ART (Assisted Reproductive Technology) cycle in a couple consisting in a cisgender women and a transgender woman]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2024:S2468-7189(24)00283-6. [PMID: 39284547 DOI: 10.1016/j.gofs.2024.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 07/01/2024] [Accepted: 09/10/2024] [Indexed: 09/30/2024]
Affiliation(s)
- Maeva Razafintsalama
- Service de médecine et biologie de la reproduction, CHU de Nantes, Nantes, France
| | - Arnaud Reignier
- Service de médecine et biologie de la reproduction, CHU de Nantes, Nantes, France
| | - Maxime Chaillot
- Service de médecine et biologie de la reproduction, CHU de Nantes, Nantes, France
| | - Thomas Freour
- Service de médecine et biologie de la reproduction, CHU de Nantes, Nantes, France; Inserm, Center for Research in Transplantation and Translational Immunology, UMR 1064, CHU de Nantes, Nantes université, 44000 Nantes, France.
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2
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Glodowski MB, Parra CM, Xin MK, Fino ME. Reproductive Considerations in the Transgender and Gender Diverse Population: A Review. Endocrinol Metab Clin North Am 2024; 53:471-482. [PMID: 39084820 DOI: 10.1016/j.ecl.2024.05.008] [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] [Indexed: 08/02/2024]
Abstract
Many transgender and gender diverse (TGD) individuals will be considering gender-affirming treatments during their reproductive lifespan. These medically necessary treatments have a negative impact on reproductive potential. All TGD individuals should be counseled regarding fertility. Options for fertility preservation for individuals who have undergone puberty include mature oocyte, embryo, and sperm cryopreservation. In prepubertal individuals, ovarian tissue cryopreservation may be considered, but testicular tissue cryopreservation remains experimental only. While there have been advances in the technology and standardization of reproductive health care for this population, many gaps remain in our knowledge which require further research.
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Affiliation(s)
- Michele B Glodowski
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, New York University Langone Health, 111 Broadway, 2nd Floor, New York, NY 10006, USA.
| | - Carlos M Parra
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynecology, New York University Langone Prelude Fertility Center, 159 East 53rd Street, 3rd Floor, New York, NY 10022, USA
| | - Madeline K Xin
- NYU Grossman School of Medicine, 550 First Avenue, New York, NY 10016, USA
| | - Mary Elizabeth Fino
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynecology, New York University Langone Prelude Fertility Center, 159 East 53rd Street, 3rd Floor, New York, NY 10022, USA
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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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4
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Tammaro A, Lori G, Martinelli A, Cancemi L, Tassinari R, Maranghi F. Risk assessment of transgender people: implementation of a demasculinizing-feminizing rodent model including the evaluation of thyroid homeostasis. Biol Direct 2024; 19:5. [PMID: 38166984 PMCID: PMC10759629 DOI: 10.1186/s13062-023-00450-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Individuals whose gender identity differs from the biological sex and the social norms are defined as transgender. Sometimes transgender undergo gender affirming hormone therapy, which lasts for the entire life making essential to evaluate its potential long-term effects. Moreover, transgender can represent a susceptible sub-group of population and specific attention is needed in risk assessment, including the development of targeted animal models. Aim of the study is the implementation of a rodent demasculinizing-feminizing model through the setting of appropriate dose of hormone therapy and the selection of specific biomarkers to evaluate the sex transition. Specific attention is paid to thyroid homeostasis due to the close link with reproductive functions. Four male adult rats/group were subcutaneously exposed to three doses plus control of β-estradiol valerate plus cyproterone acetate at: 0.045 + 0.2 (low), 0.09 + 0.2 (medium) and 0.18 + 0.2 (high) mg/dose, five times/week. The doses were selected considering the most recent recommendations for transgender woman. Sperm count, histopathological analysis (testis, liver, thyroid), testosterone, estradiol, triiodothyronine and thyroid-stimulating hormone serum levels and gene expression of sex dimorphic CYP450 were evaluated. RESULTS The doses induced feminizing-demasculinizing effects: decreased testosterone serum levels at the corresponding cisgender, increased estradiol, impairment of male reproductive function and reversal of sex-specific CYP liver expression. However, the medium and high doses induced marked liver toxicity and the low dose is considered the best choice, also for long-term studies in risk assessment. The alterations of thyroid indicated follicular cell hypertrophy supported by increased thyroid-stimulating hormone serum levels at the higher doses. CONCLUSIONS The implementation of animal models that mimic the effects of gender affirming hormone therapy is essential for supporting clinical studies in transgender people and filling data gap in order to ensure an appropriate risk assessment and a more accurate, personalized care for transgender people.
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Affiliation(s)
- Alessia Tammaro
- Center for Gender-Specific Medicine, Istituto Superiore di Sanità, Rome, Italy
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Gabriele Lori
- Center for Gender-Specific Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Andrea Martinelli
- Experimental Animal Welfare Sector, Istituto Superiore di Sanità, Rome, Italy
| | - Luigia Cancemi
- Experimental Animal Welfare Sector, Istituto Superiore di Sanità, Rome, Italy
| | - Roberta Tassinari
- Center for Gender-Specific Medicine, Istituto Superiore di Sanità, Rome, Italy.
| | - Francesca Maranghi
- Center for Gender-Specific Medicine, Istituto Superiore di Sanità, Rome, Italy
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5
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Craig Sineath R, Guerre M, Martin L, Chouhan JD. Interest In and Prior Receipt of Counseling on Fertility Preservation in Transgender Patients Presenting for Gender-affirming Orchiectomy. Urology 2023; 182:101-105. [PMID: 37517680 DOI: 10.1016/j.urology.2023.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/11/2023] [Accepted: 07/17/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE To describe the characteristics of patients presenting for gender-affirming bilateral simple orchiectomy including interest in and prior education on reproductive options prior to gonad removal. METHODS A retrospective chart review evaluated patients seeking gender-affirming bilateral orchiectomy. Data collected included age, family history, history of fertility preservation education prior to gender-affirming hormone therapy initiation, prior fertility preservation, interest in fertility preservation, and postorchiectomy surgical pathology results where applicable. RESULTS The cohort included 78 patients. 22% (n = 17) indicated reproductive options were not discussed prior to surgical consultation. 85% (n = 66) were not interested in fertility preservation. Reasons included not having an interest in biological children (74%), not wanting to delay transition (47%), and cost (36%). Patients who were married or in long-term relationships had a higher interest in fertility preservation compared to patients who were not in long-term relationships. 40% of patients with pathology data available had at least some level of spermatogenesis present in their testicular tissue. CONCLUSION Fertility preservation counseling prior to surgical referral was lower than expected. This lack of counseling could result in patients not wanting to sperm bank prior to orchiectomy as it could delay their surgical care. Increased adherence to the WPATH guidelines may improve fertility preservation interest. Our data shows a low utilization and interest in sperm preservation for transwomen and nonbinary patients seeking bilateral simple orchiectomy at our institution. Improving counseling regarding fertility preservation options earlier in transition could improve utilization of sperm cryopreservation.
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Affiliation(s)
- R Craig Sineath
- Department of Urology, Oregon Health & Science University, Portland, OR
| | - Megan Guerre
- Department of Urology, Oregon Health & Science University, Portland, OR
| | - Leigh Martin
- School of Medicine, Oregon Health & Science University, Portland, OR
| | - Jyoti D Chouhan
- Department of Urology, Oregon Health & Science University, Portland, OR.
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6
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Stolk THR, van den Boogaard E, Huirne JAF, van Mello NM. Fertility counseling guide for transgender and gender diverse people. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2023; 24:361-367. [PMID: 37901065 PMCID: PMC10601500 DOI: 10.1080/26895269.2023.2257062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Affiliation(s)
- T. H. R. Stolk
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Obstetrics & Gynaecology, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
| | - E. van den Boogaard
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Obstetrics & Gynaecology, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
| | - J. A. F. Huirne
- Department of Obstetrics & Gynaecology, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
| | - N. M. van Mello
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Obstetrics & Gynaecology, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
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7
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Jurief C, Sadiq S, Khawar S, Hamza A. Spectrum of Histologic Findings in Orchiectomy Specimens of Patients Seeking Male to Female Physical Adaptation. Int J Surg Pathol 2023; 31:1006-1013. [PMID: 36131547 DOI: 10.1177/10668969221122991] [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] [Indexed: 11/17/2022]
Abstract
Context. Hormonal therapy followed by orchiectomy is of the standard of care in management of gender identity disorder in patients seeking male to female transition. The orchiectomy specimens from these patients are routinely subjected to histopathologic evaluation. We discuss the spectrum of histopathologic findings, incidental findings, and cost analysis of processing these specimens. Design. Orchiectomy specimens from patients seeking male to female transition received at our institution from January 2019 to June 2021 were included in the study. Data including patient age, history of hormonal therapy, testicular weight, histopathologic findings, number of tissue sections, and processing cost were collected. Results. A total of 79 specimens were identified. Mean patient age was 36.7 ± 14.5 years. Mean testicular weight was 28.0 ± 8.3 g (right) and 27.8 ± 9.1 g (left). Histologic evaluation showed diminished or absent spermatogenesis in 100% and fibrosis of seminiferous tubules in 96% of specimens. Benign, incidental findings, none of which altered patient management were present in 6 specimens (8%). For most specimens, 3 sections per testis were submitted. This resulted in a mean of 5.8 ± 1.1 tissue sections submitted per specimen. Conclusions. Orchiectomy specimens from patients with gender dysphoria always demonstrate hormone-therapy effects albeit with varying degree. The chances of discovering any incidental finding of clinical significance are negligible. Diligent gross inspection and minimal tissue sampling with additional sampling reserved for gross abnormalities can adequately document the histologic findings in a cost-effective manner.
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Affiliation(s)
- Christopher Jurief
- Pathology, University of Kansas, School of Medicine, Kansas City, KS, USA
| | - Sabika Sadiq
- Lake Erie College of Osteopathic Medicine Bradenton Campus, Bradenton, FL, USA
| | - Sidrah Khawar
- Pathology, University of Kansas, School of Medicine, Kansas City, KS, USA
| | - Ameer Hamza
- Pathology, University of Kansas, School of Medicine, Kansas City, KS, USA
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8
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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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9
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Hartman N, James C, Barrera EP, Grimstad FW, El-Arabi AM. Effects on Fertility and the Preservation of Fertility in the Transgender Patient. CURRENT SEXUAL HEALTH REPORTS 2023. [DOI: 10.1007/s11930-023-00355-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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10
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Defreyne J, Vander Stichele C, Iwamoto SJ, T'Sjoen G. Gender-affirming hormonal therapy for transgender and gender-diverse people-A narrative review. Best Pract Res Clin Obstet Gynaecol 2023; 86:102296. [PMID: 36596713 PMCID: PMC11197232 DOI: 10.1016/j.bpobgyn.2022.102296] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/07/2022] [Indexed: 12/23/2022]
Abstract
As the number of transgender and gender-diverse (TGD) people accessing gender-affirming care increases, the need for healthcare professionals (HCPs) providing gender-affirming hormonal therapy (GAHT) also increases. This chapter provides an overview of the HCPs interested in getting involved in providing GAHT.
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Affiliation(s)
- J Defreyne
- Department of Endocrinology and Center for Sexology, Ghent University Hospital, Ghent, Belgium.
| | - Clara Vander Stichele
- Department of Endocrinology and Center for Sexology, Ghent University Hospital, Ghent, Belgium.
| | - Sean J Iwamoto
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, and Rocky Mountain Regional VA Medical Center, Aurora, CO, USA.
| | - G T'Sjoen
- Department of Endocrinology and Center for Sexology, Ghent University Hospital, Ghent, Belgium.
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11
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de Nie I, van Mello NM, Vlahakis E, Cooper C, Peri A, den Heijer M, Meißner A, Huirne J, Pang KC. Successful restoration of spermatogenesis following gender-affirming hormone therapy in transgender women. Cell Rep Med 2023; 4:100858. [PMID: 36652919 PMCID: PMC9873819 DOI: 10.1016/j.xcrm.2022.100858] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 09/08/2022] [Accepted: 11/18/2022] [Indexed: 01/19/2023]
Abstract
Increasing numbers of transgender individuals are presenting for gender-affirming medical care. For trans women, gender-affirming hormone therapy (GAHT) promotes feminization but also inhibits spermatogenesis. There is a common untested assumption that this inhibition is permanent, resulting in infertility. In this longitudinal study, we report the recovery of viable spermatozoa in nine trans women who stopped GAHT for reproductive purposes. Our preliminary findings suggest that the negative impact of GAHT on spermatogenesis can be reversed, casting doubt on previous claims that GAHT in trans women inevitably leads to permanent infertility. Larger studies are needed to confirm our findings, which have implications not only for fertility counseling and the reproductive options of transgender individuals but also efforts to restrict access to GAHT based on fertility grounds.
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Affiliation(s)
- Iris de Nie
- Department of Endocrinology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands,Center of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Norah M. van Mello
- Center of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands,Department of Obstetrics and Gynecology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Emanuel Vlahakis
- Coffs Harbour Sexual Health Clinic, Coffs Harbour, NSW, Australia
| | - Charlie Cooper
- Clinical Sciences, Murdoch Children’s Research Institute, Parkville, VIC, Australia,Department of Adolescent Medicine, Royal Children’s Hospital, Melbourne, VIC, Australia
| | - Angus Peri
- Clinical Sciences, Murdoch Children’s Research Institute, Parkville, VIC, Australia,Department of Adolescent Medicine, Royal Children’s Hospital, Melbourne, VIC, Australia
| | - Martin den Heijer
- Department of Endocrinology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands,Center of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Andreas Meißner
- Department of Endocrinology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands,Center of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands,Department of Urology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Judith Huirne
- Department of Obstetrics and Gynecology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Ken C. Pang
- Clinical Sciences, Murdoch Children’s Research Institute, Parkville, VIC, Australia,Department of Adolescent Medicine, Royal Children’s Hospital, Melbourne, VIC, Australia,Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia,Corresponding author
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12
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Yau M, Safer JD. The return of spermatogenesis in transgender women ceasing gender-affirming hormone therapy. Cell Rep Med 2023; 4:100835. [PMID: 36652904 PMCID: PMC9873818 DOI: 10.1016/j.xcrm.2022.100835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Fertility has become a priority in transgender health research. In this issue of Cell Reports Medicine, a study by de Nie et al.1 of nine transgender women demonstrates sperm production after the cessation of gender-affirming hormone therapy (GAHT). Their results suggest the transient nature of gonadal suppression by GAHT.
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Affiliation(s)
- Mabel Yau
- Mount Sinai Center for Transgender Medicine and Surgery, New York, NY, USA; Division of Pediatric Endocrinology, Mount Sinai Kravis Children's Hospital, New York, NY, USA.
| | - Joshua D Safer
- Mount Sinai Center for Transgender Medicine and Surgery, New York, NY, USA; Division of Endocrinology, Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, New York, NY, USA
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13
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OH JW, Yun Y, Lee ES. A Review of Gender-Affirming Hormone Therapy for Transgender and Gender Diverse Adults in South Korea. J Menopausal Med 2022; 28:92-102. [PMID: 36647272 PMCID: PMC9843037 DOI: 10.6118/jmm.22039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 12/21/2022] [Accepted: 12/21/2022] [Indexed: 01/14/2023] Open
Abstract
Recently, gender-affirming hormone therapy for gender incongruence has become an issue in various countries and organizations with various guidelines. In South Korea, several clinical treatments are also used with many possible options. These treatments include masculinizing (female-to-male [FTM]) or feminizing (male-to-female [MTF]) hormone therapies, with regimens usually driven by standards of hormonal replacement therapy for hypogonadism (i.e., hypogonadal natal men and postmenopausal women). This cross-sex hormone therapy can change patients' physical appearance to better match their gender identity and expression. Regarding masculinizing therapy, injection and transdermal gel types of testosterone are used according to international guidelines. Progesterone is utilized in the form of oral pills, injections, or intrauterine devices to suppress menstruation and avoid pregnancy. Essentially, feminizing therapy uses androgen blockers along with estrogen. This is because estrogen alone cannot exert sufficient androgen-suppressing effects. In South Korea, the most commonly used androgen blockers are spironolactone and cyproterone acetate. Gonadotropin-releasing hormone (GnRH) agonist is also available. Regarding estrogen, oral pills, injections, and transdermal gels are utilized. This review introduces these gender-affirming hormone therapies in South Korea and discusses the side effects of each regimen.
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Affiliation(s)
- Jeong-Won OH
- Department of Obstetrics and Gynecology, Soon Chun Hyang University Seoul Hospital, Soon Chun Hyang University College of Medicine, Seoul, Korea
| | - Yeoul Yun
- Department of Obstetrics and Gynecology, Soon Chun Hyang University Seoul Hospital, Soon Chun Hyang University College of Medicine, Seoul, Korea
| | - Eun Sil Lee
- Department of Obstetrics and Gynecology, Soon Chun Hyang University Seoul Hospital, Soon Chun Hyang University College of Medicine, Seoul, Korea
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14
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Puy V, Magnan F, Lousqui J, Boumerdassi Y, Bennani Smires B, Mendes N, Eustache F. Préservation de la fertilité chez les personnes transgenres. Med Sci (Paris) 2022; 38:926-933. [DOI: 10.1051/medsci/2022154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
La majorité des personnes transgenres envisage de fonder une famille, mais leur fertilité peut être altérée par l’affirmation du genre. L’hormonothérapie peut affecter durablement la production de gamètes, notamment chez les femmes trans. La chirurgie de réassignation sexuelle entraîne une stérilité définitive. En France, des réseaux de professionnels de santé se sont organisés. Ils recommandent l’accès à la préservation de la fertilité dans le cadre de la transidentité. Cependant, le recueil de gamètes reste souvent difficile en raison de l’incongruence hormonale pour les femmes trans, ou du caractère invasif de la procédure pour les hommes trans. De futures études permettront de statuer sur l’utilisation des gamètes autoconservés.
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15
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Brouillet S, Ducrocq B, Mestres S, Guillemain C, Ravel C, Reignier A. [Fertility preservation and access to medically assisted reproduction for Trans people: Guidelines from French Professional Association for Transgender Health]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2022; 50:682-688. [PMID: 35750197 DOI: 10.1016/j.gofs.2022.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 06/15/2023]
Abstract
Many health care professionals are dealing with the issue of transgender people in their medical practice. In the field of reproduction, Trans people can benefit from fertility preservation before the introduction of hormonal treatment or surgery altering their fertility. This article, which is the result of a collaborative work of several reproductive professionals involved in the health of Trans people, provides an overview of the possibilities of fertility preservation and medically assisted reproduction techniques in France for Trans people.
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Affiliation(s)
- S Brouillet
- Inserm 1203 DEFE, département de biologie de la reproduction, CHU de Montpellier, université de Montpellier, Montpellier, France
| | - B Ducrocq
- CECOS, CHU de Lille, institut de biologie de la reproduction, Lille, France
| | - S Mestres
- Assistance médicale à la procréation, CECOS, CHU de Clermont-Ferrand, CHU d'Estaing, Clermont-Ferrand, France
| | - C Guillemain
- Pôle femmes-parents-enfants, centre clinicobiologique d'assistance médicale à la procréation - CECOS, APHM, hôpital La Conception, 13385 Marseille cedex 5, France
| | - C Ravel
- Inserm, service de biologie de la reproduction - CECOS, EHESP, CHU de Rennes, université Rennes, Irset (institut de recherche en santé, environnement et travail) - UMR_S 1085, 35000 Rennes, France
| | - A Reignier
- Inserm, biologie et médecine de la reproduction et gynécologie médicale, centre de recherche en transplantation et immunologie, UMR 1064, CHU de Nantes, Nantes université, Nantes, France.
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16
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Cornejo KM, Oliva E, Crotty R, Sadow PM, Devins K, Wintner A, Wu CL. Clinicopathologic features and proposed grossing protocol of orchiectomy specimens performed for gender affirmation surgery. Hum Pathol 2022; 127:21-27. [PMID: 35660072 PMCID: PMC9489654 DOI: 10.1016/j.humpath.2022.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/23/2022] [Accepted: 05/25/2022] [Indexed: 01/17/2023]
Abstract
Gender affirmation surgery performed for gender dysphoria is increasing to instigate changes more closely approximating gender identity. We investigated the clinicopathologic features of gender-affirming orchiectomies performed at our institution and devised a grossing protocol for these increasingly encountered specimens. We obtained 45 orchiectomies from 23 patients and reviewed clinicopathologic features. The number of sections per case was noted and reviewed to devise an optimal grossing protocol to assess pathologic findings. Twenty-three patients had bilateral orchiectomy with 1 unilateral. The average patient age was 39.4 years (range, 21-71 years); all received hormones for a mean of 66.1 months (range, 12-348 months). The average number of slides per orchiectomy was 8 slides (range, 1-11). Aspermatogenesis occurred in 32 (71%), hypospermatogenesis in 8 (18%), and normal spermatogenesis in 5 (11%) testes. Twenty-five (56%) exhibited scattered cells with nuclear cytomegaly, concerning for germ cell neoplasia in situ (GCNIS), but OCT4 negative. Six (13%) had multinucleated stromal cells. Leydig cells were markedly reduced/absent in 38 testes (85%). Epithelial hyperplasia was identified in 15 rete testes (33%) and 24 epididymes (53%), while 18 (40%) showed periepididymal muscular hyperplasia. All findings were identified in the initial 2 slides including rete testis/epididymis, except for 3 cases, missing only focal tubular sclerosis. Despite all received treatment, only a subset showed changes of exogenous hormone therapy. The presence of nuclear cytomegaly can mimic GCNIS and may be a potential pitfall. Two sections to include rete testis/epididymis and a third of cord margin are sufficient to identify the relevant pathology and germ cell tumors overall are uncommon in orchiectomies performed for gender affirmation.
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Affiliation(s)
- Kristine M Cornejo
- Department of Pathology, Massachusetts General Hospital, Boston, MA, 02114, USA.
| | - Esther Oliva
- Department of Pathology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Rory Crotty
- Department of Pathology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Peter M Sadow
- Department of Pathology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Kyle Devins
- Department of Pathology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Anton Wintner
- Department of Urology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Chin-Lee Wu
- Department of Pathology, Massachusetts General Hospital, Boston, MA, 02114, USA
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17
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Affiliation(s)
- Ameer Hamza
- University of Kansas Medical Center, Department of Pathology and Laboratory Medicine, Kansas City, Kansas, USA
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18
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Bensley JG, Cheung AS, Grossmann M, Papa N. Testicular Cancer in Trans People Using Feminising Hormone Therapy- A Brief Review. Urology 2021; 160:1-4. [PMID: 34826522 DOI: 10.1016/j.urology.2021.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/07/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Jonathan Guy Bensley
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
| | - Ada S Cheung
- Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Victoria, Australia
| | - Mathis Grossmann
- Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Victoria, Australia
| | - Nathan Papa
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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19
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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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20
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Sineath RC, Blasdel G, Dy GW. Addressing urologic health disparities in sexual and gender minority communities through patient-centered outcomes research. Urology 2021; 166:66-75. [PMID: 34774931 DOI: 10.1016/j.urology.2021.08.065] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 06/28/2021] [Accepted: 08/11/2021] [Indexed: 10/19/2022]
Abstract
Sexual and gender minority (SGM) communities face stigma and discrimination that impact all aspects of health. To better understand and improve their urologic health outcomes, we must study SGM patients as a distinct population and pursue research on outcomes identified as priorities to SGM communities. Patient-centered outcomes research (PCOR) is a methodology which is increasingly familiar to urologists and is crucial to adequately addressing SGM health in future urological research. We review existing literature focused on urologic outcomes of SGM populations and highlight specific PCOR initiatives built on SGM community engagement.
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Affiliation(s)
- R Craig Sineath
- Department of Urology, Oregon Health & Science University, Portland, Oregon.
| | - Gaines Blasdel
- Department of Urology, New York University Grossman School of Medicine, New York, New York
| | - Geolani W Dy
- Department of Urology, Oregon Health & Science University, Portland, Oregon
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21
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Sinha A, Mei L, Ferrando C. The effect of estrogen therapy on spermatogenesis in transgender women. F S Rep 2021; 2:347-351. [PMID: 34553162 PMCID: PMC8441557 DOI: 10.1016/j.xfre.2021.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 05/21/2021] [Accepted: 06/04/2021] [Indexed: 11/29/2022] Open
Abstract
Objective To describe the histopathologic parameters of orchiectomy specimens obtained after gender-affirming surgery from transgender women who used gender-affirming hormone therapy (GAHT), which included estrogen and spironolactone. Our hypothesis was that an increasing duration of GAHT affects testicular health. Design Retrospective cohort study. Setting Tertiary referral center. Patient(s) All transgender women (individuals assigned male at birth who identified as female) who underwent orchiectomy with or without vaginoplasty between December 2015 and March 2020. Intervention(s) GAHT (estrogen and spironolactone) in the setting of patients with orchiectomy with or without vaginoplasty. Main Outcome Measure(s) Demographic and perioperative data and pathology records were reviewed. The following pathology parameters were recorded: testicular volume, testicular weight, presence of spermatogenesis (active vs. reduced), maturation arrest, testicular atrophy, hyalinization, scarring/fibrosis, and Sertoli cell and Leydig cell phenotypes. The patients were grouped into one of three categories describing the duration of GAHT use: 0–36 months, 37–60 months, and >60 months years. Descriptive statistics were performed and comparisons between outcomes (demographic data and pathology parameters) were made among the GAHT groups. Result(s) Eighty-five (N = 85) patients underwent orchiectomy during the study period with 85.9% (n = 73) undergoing concurrent vaginoplasty. The mean (SD) age and body mass index of the cohort were 39 ±16 years and 28.4 ± 5.4 kg/m2, respectively. In addition, although this was not statistically significant, patients in the 37–60 and >60-month groups were more likely to smoke marijuana than those in the 0–36-month group (26.3% and 21.2% vs. 4.2%, respectively). Mean testicular weight and volume across the cohort were 60.1 ± 24.9 grams and 65.5 ± 41.1 cm3, respectively. Spermatogenesis was present in 28.2% (n = 24) of specimens with active spermatogenesis noted in 8.2% (n = 7). Hyalinization, scarring/fibrosis, and atrophy were present in 28.2% (n = 24), 20.0% (n = 17), and 25.9% (n = 22) of specimens, respectively. There were no differences in pathology parameters across the GAHT groups. Testicular weight and volume were not associated with any differences in pathology parameters. Additionally, age was not associated with testicular weight, volume, or pathology parameters with the exception of the following: when patients were categorized as either ≤40 years of age (n = 48) vs. > 40 years of age (n = 37), patients who were older were more likely to have hyalinization (43.2% vs. 16.7%) as well as atrophy (40.5% vs. 14.6%). Conclusion(s) The duration of GAHT use was not associated with any differences in orchiectomy pathology parameters in patients undergoing gender-affirming surgery, and some patients may still have some spermatogenesis based on the parameters observed in this study.
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Affiliation(s)
- Annika Sinha
- Department of Obstetrics and Gynecology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Lin Mei
- Department of Obstetrics and Gynecology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Cecile Ferrando
- Department of Obstetrics and Gynecology, Cleveland Clinic Foundation, Cleveland, Ohio
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22
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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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23
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Vereecke G, Defreyne J, Van Saen D, Collet S, Van Dorpe J, T'Sjoen G, Goossens E. Characterisation of testicular function and spermatogenesis in transgender women. Hum Reprod 2021; 36:5-15. [PMID: 33257947 DOI: 10.1093/humrep/deaa254] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/08/2020] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION Does gender-affirming treatment prevent full spermatogenesis in transgender women (TW)? SUMMARY ANSWER Adequate hormonal therapy (HT) leads to complete suppression of spermatogenesis in most TW, if serum testosterone levels within female reference ranges are obtained. WHAT IS KNOWN ALREADY Gender-affirming treatment in transgender individuals may involve gender-affirming HT. The effects on spermatogenesis in TW remain unclear. In order to add information from a referral centre for transgender care, we wish to compare results of earlier studies with our population of TW who received a standard hormone treatment. STUDY DESIGN, SIZE, DURATION This was a prospective cohort study part of the European Network for the Investigation of Gender Incongruence (ENIGI), conducted between 15 February 2010 and 30 September 2015. There were 162 TW were included in the ENIGI study at the Ghent University Hospital in Belgium. Participants are included in ENIGI when they first start HT, and follow-up visits occur over the next 3 years. PARTICIPANTS/MATERIALS, SETTING METHODS The study included 97 TW who initiated HT with cyproterone acetate (CPA) plus oestrogens and proceeded with gonadectomy at the Ghent University Hospital. Testicular tissue retrieved during gonadectomy was processed and stained for four different germ cell markers by the Biology of the Testis lab at the Vrije Universiteit Brussel. Subsequent immunohistochemical staining was performed for melanoma-associated antigen A4 (MAGE-A4, marker for spermatogonia and early spermatocytes), boule homologue, RNA-binding protein (BOLL, marker for secondary spermatocytes and round spermatids), cAMP-responsive element modulator (CREM, marker for round spermatids) and acrosin (marker for acrosome visualization). Serum levels of sex steroids were measured prior to surgery. MAIN RESULTS AND THE ROLE OF CHANCE Suppressed testosterone levels (<50 ng/dl) were found in 92% of the participants prior to surgery. The mean time between initiation of HT and surgery was 685 days. In 88% (85/97) of the sections, MAGE-A4 staining was positive. Further staining could not reveal complete spermatogenesis in any participant. LIMITATIONS, REASONS FOR CAUTION Testicular function of the participants prior to initiation of HT was not assessed, although all participants presented with cisgender male serum testosterone values before initiation of HT. The current study only reports on people using CPA at a fixed dose and may therefore not be applicable to all TW. WIDER IMPLICATIONS OF THE FINDINGS HT leads to complete suppression of spermatogenesis in most TW, if serum testosterone levels within female reference ranges are obtained. Serum testosterone levels are associated with the sperm maturation rate. It is important to discuss sperm preservation before the start of hormone therapy. If serum testosterone levels remain higher, spermatogenesis may still occur. STUDY FUNDING/COMPETING INTEREST(S) D.V.S. is a post-doctoral fellow of the Fonds Wetenschappelijk Onderzoek (FWO; 12M2819N). Processing of the testis specimens was funded by the Biology of The Testes (BITE) research group (Department of Reproduction, Genetics and Regenerative medicine at Vrije Universiteit Brussel (VUB)). There are no competing interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Gertjan Vereecke
- Department of Endocrinology, AZ Groeninge, 8500 Kortrijk, Belgium
| | - Justine Defreyne
- Department of Endocrinology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Dorien Van Saen
- Department of Genetics and Regenerative Medicine, Biology of the Testis, Research Cluster Reproduction, Genetics and Regenerative Medicine, Vrije Universiteit Brussel, 1090 Brussels, Belgium
| | - Sarah Collet
- Department of Endocrinology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Jo Van Dorpe
- Department of Pathology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Guy T'Sjoen
- Department of Endocrinology and Center for Sexology and Gender, Ghent University Hospital, 9000 Ghent, Belgium
| | - Ellen Goossens
- Department of Genetics and Regenerative Medicine, Biology of the Testis, Research Cluster Reproduction, Genetics and Regenerative Medicine, Vrije Universiteit Brussel, 1090 Brussels, Belgium
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24
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Andrews AR, Kakadekar A, Schmidt RL, Murugan P, Greene DN. Histologic Findings in Surgical Pathology Specimens From Individuals Taking Feminizing Hormone Therapy for the Purpose of Gender Transition: A Systematic Scoping Review. Arch Pathol Lab Med 2021; 146:252-261. [PMID: 33983412 DOI: 10.5858/arpa.2020-0704-ra] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Transgender women experience health disparities in all areas of medicine. Within surgical pathology, knowledge gaps relating to the concepts of transgender care exist. Medical transition for transgender women and transfeminine persons may involve hormone therapy and/or surgery to feminize the body. Understanding the common histologic changes in specimens from feminizing surgeries, as well as other specimens from patients on feminizing hormone therapy, will aid surgical pathologists in providing better care to this unique patient population. OBJECTIVE.— To summarize histologic findings in surgical pathology specimens from transgender women taking feminizing hormones. DATA SOURCES.— A systematic review of the OVID Medline and PubMed databases was performed to identify all studies describing histologic findings in surgical pathology specimens from transgender women from 1946 to 2019. CONCLUSIONS.— Much of the literature to date describing histologic findings in transgender women comes from the examination of genitourinary specimens removed during feminizing surgeries. Common benign changes associated with feminizing hormone therapy include the development of acini and lobules in the breast, testicular tubular changes, and squamous metaplasia of the prostate and urethra. Neoplastic cases include breast adenocarcinoma and fibroepithelial lesions, testicular germ cell tumors, prostatic adenocarcinoma, anal squamous cell carcinoma, pituitary adenomas, and meningiomas. Additional studies assessing the findings in other organ systems as well as population-based studies assessing rates of neoplasia are needed. However, future research relies on engagement within the surgical pathology community as well as collaboration with clinicians and patients to achieve optimal results.
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Affiliation(s)
- Alicia R Andrews
- From the Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, Canada (Andrews, Kakadekar)
| | - Archan Kakadekar
- From the Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, Canada (Andrews, Kakadekar)
| | - Robert L Schmidt
- the Department of Pathology, University of Utah, Salt Lake City (Schmidt)
| | - Paari Murugan
- the Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis (Murugan)
| | - Dina N Greene
- the Department of Laboratory Medicine, University of Washington, Seattle (Greene)
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25
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Abstract
Social acceptance and legal protections for transgender and gender nonconforming patients have increased over the past decade, but significant health care disparities still remain. Such an area of disparity is discussion with and interventions for fertility, contraception, pregnancy, and lactation in TGNC patients. Providing optimal care starts with creating a welcoming and safe environment. Appropriate preconception education includes the effects of gender-affirming therapies (both surgical and nonsurgical) on fertility as well the fertility preservation techniques that are available. However, as gamete retrieval requires natal hormone stimulation, gender dysphoria may be worsened. Thus, these patients should be carefully monitored not only medically, but also with regard to their mental health. In addition to assisted reproductive technologies, protocols exist to aid with induction of lactation as well as discontinuation if desired. As this is a growing field of medicine with limited data available on safety and long-term outcomes, recommendations are for a multidisciplinary team approach to ensure patients' safety and well-being.
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Affiliation(s)
- Sajal Patel
- Division of Endocrinology, Diabetes, and Metabolism, Virginia Commonwealth University Hospital System, Richmond, Virginia, USA
| | - Lori B Sweeney
- Division of Endocrinology & Metabolism, Central Virginia VA Health Care System, Richmond, Virginia, USA
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26
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Stewart MK, Mattiske DM, Pask AJ. Exogenous Oestrogen Impacts Cell Fate Decision in the Developing Gonads: A Potential Cause of Declining Human Reproductive Health. Int J Mol Sci 2020; 21:E8377. [PMID: 33171657 PMCID: PMC7664701 DOI: 10.3390/ijms21218377] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/06/2020] [Accepted: 11/06/2020] [Indexed: 12/12/2022] Open
Abstract
The increasing incidence of testicular dysgenesis syndrome-related conditions and overall decline in human fertility has been linked to the prevalence of oestrogenic endocrine disrupting chemicals (EDCs) in the environment. Ectopic activation of oestrogen signalling by EDCs in the gonad can impact testis and ovary function and development. Oestrogen is the critical driver of ovarian differentiation in non-mammalian vertebrates, and in its absence a testis will form. In contrast, oestrogen is not required for mammalian ovarian differentiation, but it is essential for its maintenance, illustrating it is necessary for reinforcing ovarian fate. Interestingly, exposure of the bi-potential gonad to exogenous oestrogen can cause XY sex reversal in marsupials and this is mediated by the cytoplasmic retention of the testis-determining factor SOX9 (sex-determining region Y box transcription factor 9). Oestrogen can similarly suppress SOX9 and activate ovarian genes in both humans and mice, demonstrating it plays an essential role in all mammals in mediating gonad somatic cell fate. Here, we review the molecular control of gonad differentiation and explore the mechanisms through which exogenous oestrogen can influence somatic cell fate to disrupt gonad development and function. Understanding these mechanisms is essential for defining the effects of oestrogenic EDCs on the developing gonads and ultimately their impacts on human reproductive health.
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Affiliation(s)
- Melanie K. Stewart
- School of BioSciences, The University of Melbourne, Melbourne, VIC 3010, Australia; (D.M.M.); (A.J.P.)
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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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Jones NC, Otto AK, Ketcher DE, Permuth JB, Quinn GP, Schabath MB. Inclusion of transgender and gender diverse health data in cancer biorepositories. Contemp Clin Trials Commun 2020; 19:100597. [PMID: 32613134 PMCID: PMC7317667 DOI: 10.1016/j.conctc.2020.100597] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 06/04/2020] [Accepted: 06/14/2020] [Indexed: 02/08/2023] Open
Abstract
Biobanks have the potential to be robust resource for understanding potential cancer risks associated with gender-affirming interventions. In this narrative review, we synthesized the current published literature regarding the inclusion of TGD health data in cancer biorepositories and cancer research conducted on biospecimens. Of the 6986 initial results, 153 (2.2%) assessed the biological effects of gender-affirming interventions on TGD tissues. Within that category, only one paper examined transgender tissues in relation to cancer biobanks. Strategies are offered to address the inequities in TGD tissue-based research and diversify the field of biobanking as a whole.
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Affiliation(s)
- Nat C Jones
- University of South Florida, Morsani College of Medicine, Tampa, FL, USA.,H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Amy K Otto
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Dana E Ketcher
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | | | - Matthew B Schabath
- University of South Florida, Morsani College of Medicine, Tampa, FL, USA.,H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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Fertility Preservation in the Transgender Population. CURRENT SEXUAL HEALTH REPORTS 2020. [DOI: 10.1007/s11930-020-00238-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Defreyne J, Van Schuylenbergh J, Motmans J, Tilleman K, T’Sjoen G. Parental desire and fertility preservation in assigned male at birth transgender people living in Belgium. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2020; 21:45-57. [PMID: 33015658 PMCID: PMC7430479 DOI: 10.1080/15532739.2019.1692750] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Introduction: Transgender people who chose to proceed with gender affirming hormonal and/or surgical therapy, may face reduced options for fulfilling their parental desire in the future. The ideas and concerns of adult transgender people regarding fertility preservation and parental desire have never been reported in a large, non-clinical sample of assigned male at birth (AMAB) transgender people. Methods: A web-based survey on fertility and parenthood in (binary and non-binary) transgender people was conducted in Belgium. AMAB people were selected for this analysis. Results: We included 254 AMAB persons, of which 196 (77.2%) self-identified as transgender women (TW), 14 (5.5%) as cross-dressers and 44 (17.3%) as gender non-binary (GNB) people. Fifty-five (21.6%) respondents had a current/future parental desire, parental desire was already fulfilled in 81 (31.9%) and not present in 57 people (22.4%) (other: 19.2%). TW were more likely to express a parental desire, compared to GNB people and cross-dressers (P = 0.004). In total, 196 AMAB people previously sought medical assistance, of which 30 (15.3%) considered the loss of fertility due to the transitioning process undesirable. The majority (68.2%) did not want fertility preservation (FP). Fourteen people (9.8%) had proceeded with FP. The main reasons not to proceed with FP included not feeling the need (70; 68.0%), not desiring a genetic link with (future) child(ren) (20; 19.4%) and having to postpone hormone treatment (15; 14.6%). TW were more likely to have a parental desire and to have cryopreserved or to consider cryopreserving gametes, compared to GNB people. Conclusion: Parental desire and FP use were lower in the current non-clinical sample than in previous research on clinical samples. This can possibly be explained by the barriers transgender people face when considering fertility options, including postponing hormone therapy. Also, GNB persons have different needs for gender affirming treatment and FP.
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Affiliation(s)
- Justine Defreyne
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
- CONTACT Justine Defreyne Department of Endocrinology, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Judith Van Schuylenbergh
- Center for Sexology and Gender, Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Joz Motmans
- Center for Sexology and Gender, Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Kelly Tilleman
- Department for Reproductive Medicine, Ghent University Hospital, Ghent, Belgium
| | - Guy T’Sjoen
- Center for Sexology and Gender, Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
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