1
|
Bitan R, Magnezi R, Kedem A, Avraham S, Youngster M, Yerushalmi G, Kaufman S, Umanski A, Hourvitz A, Gat I. Autologous sperm usage after cryopreservation-the crucial impact of patients' characteristics. Andrology 2024; 12:527-537. [PMID: 37528799 DOI: 10.1111/andr.13502] [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: 02/20/2023] [Revised: 07/05/2023] [Accepted: 07/27/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND The wide implementation of sperm freezing presents a growing burden on sperm banks. OBJECTIVES To evaluate sperm freezing and usage patterns over 30 years, according to demographic parameters of age at first cryopreservation and number of children, and indication for cryopreservation. MATERIAL AND METHODS This retrospective, population based, cohort study included all sperm cryopreservation cases performed at a tertiary referral center from October 1993 to December 2021, among patients aged 18 years and older. First, we determined the interval between first sperm sample and use. Then, we examined sperm usage separately for: (1) age, comparing patients grouped into 5-year age cohorts; (2) paternal status according to number of children; (3) indication, comparison among seven indications. Secondary analysis included correlations between main age groups and paternal status versus the four most common indications found. RESULTS During the study period 1490 men who cryopreserved sperm met the inclusion criteria. Average age at cryopreservation of the first sample was 33.9 ± 8.1 years. Average age at first sperm use was 37 ± 8.5 years. Cumulative sperm usage was 38.7% after 17.8 years. Increasing age was associated with progressive increase in sperm usage rate and shorter preservation period. Use significantly decreased with increasing number of children. Examination of seven reasons for sperm cryopreservation found the highest cumulative sperm usage was related to azoospermia (67.7%), followed by functional cryopreservation (39.3%), oligoasthenoteratospermia (27.3%), other (26.5%), patient's request (24%), cancer (19%), and systemic disease (7.2%). Secondary analysis defined specific usage patterns mainly related to age and indication, with less of an effect based on the number of children. DISCUSSION AND CONCLUSION After decades of cryopreservation, the paradigm of sperm cryopreservation is mostly related to cancer patients. This should be reevaluated and evolve to include broader patient-targeted factors and perceptions.
Collapse
Affiliation(s)
- Roy Bitan
- Department of Management, Health Systems Management Program, Bar Ilan University, Ramat Gan, Israel
- Sperm Bank & Andrology Unit, Shamir Medical Center, Zerifin, Tzrifin, Israel
| | - Racheli Magnezi
- Department of Management, Health Systems Management Program, Bar Ilan University, Ramat Gan, Israel
| | - Alon Kedem
- IVF Department, Shamir Medical Center, Zerifin, Tzrifin, Israel
- Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Sarit Avraham
- IVF Department, Shamir Medical Center, Zerifin, Tzrifin, Israel
| | | | - Gil Yerushalmi
- IVF Department, Shamir Medical Center, Zerifin, Tzrifin, Israel
| | - Sarita Kaufman
- Sperm Bank & Andrology Unit, Shamir Medical Center, Zerifin, Tzrifin, Israel
| | - Ana Umanski
- Sperm Bank & Andrology Unit, Shamir Medical Center, Zerifin, Tzrifin, Israel
| | - Ariel Hourvitz
- IVF Department, Shamir Medical Center, Zerifin, Tzrifin, Israel
- Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Itai Gat
- Sperm Bank & Andrology Unit, Shamir Medical Center, Zerifin, Tzrifin, Israel
- IVF Department, Shamir Medical Center, Zerifin, Tzrifin, Israel
- Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
2
|
Berry AW, Monro S. Ageing in obscurity: a critical literature review regarding older intersex people. Sex Reprod Health Matters 2022; 30:2136027. [DOI: 10.1080/26410397.2022.2136027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Adeline W. Berry
- Marie Curie Research Fellow, University of Huddersfield, Huddersfield, UK. Correspondence:
| | - Surya Monro
- Professor of Sociology and Social Policy, University of Huddersfield, Huddersfield, UK
| |
Collapse
|
3
|
Giacomozzi M, Health MSG, Aubin SG, Brancaccio MT. Mapping Accessibility to Fertility Preservation for Trans Masculine Individuals in the Netherlands. LGBT Health 2022; 9:369-383. [PMID: 35533011 DOI: 10.1089/lgbt.2021.0302] [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: Since 2014 in the Netherlands, sterilization is no longer required for legal gender affirmation. Access to fertility preservation (FP) options is indispensable to grant equal reproductive rights to this population. This study aims to map existing literature on barriers and enabling factors for trans masculine individuals to access FP in the Netherlands after 2014. Methods: A scoping review method was conducted, including a database and a hand search complemented with informal consultations. Literature between 2014 and 2021 was searched. Results: A total of 38 peer-reviewed articles and 22 complementary gray literature sources were retrieved. Thematic analysis identified seven common themes: biological, psychological, training, language, law and legislation, economic, and sociocultural. The themes were clustered as patient-, health care provider (HCP)- and environment-related. Conclusion: The Netherlands offers progressive legislation and accommodating insurance agreements that favor FP for trans masculine individuals. However, the current readiness of HCPs to provide adapted and tailored care is arguable, and the capacity to access appropriate health services for trans masculine individuals is largely nonexistent outside of highly specialized health institutions. The implementation of both formal and informal education training programs for HCPs on transgender and gender diverse health needs-as well as inclusive language use-could benefit this community at large.
Collapse
Affiliation(s)
| | - MSc Global Health
- Department of Health, Ethics and Society, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | | | - Maria Teresa Brancaccio
- Department of Health, Ethics and Society, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| |
Collapse
|
4
|
Moseson H, Fix L, Gerdts C, Ragosta S, Hastings J, Stoeffler A, Goldberg EA, Lunn MR, Flentje A, Capriotti MR, Lubensky ME, Obedin-Maliver J. Abortion attempts without clinical supervision among transgender, nonbinary and gender-expansive people in the United States. BMJ SEXUAL & REPRODUCTIVE HEALTH 2022; 48:e22-e30. [PMID: 33674348 PMCID: PMC8685648 DOI: 10.1136/bmjsrh-2020-200966] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/09/2021] [Accepted: 02/15/2021] [Indexed: 06/01/2023]
Abstract
BACKGROUND Transgender, nonbinary and gender-expansive (TGE) people face barriers to abortion care and may consider abortion without clinical supervision. METHODS In 2019, we recruited participants for an online survey about sexual and reproductive health. Eligible participants were TGE people assigned female or intersex at birth, 18 years and older, from across the United States, and recruited through The PRIDE Study or via online and in-person postings. RESULTS Of 1694 TGE participants, 76 people (36% of those ever pregnant) reported considering trying to end a pregnancy on their own without clinical supervision, and a subset of these (n=40; 19% of those ever pregnant) reported attempting to do so. Methods fell into four broad categories: herbs (n=15, 38%), physical trauma (n=10, 25%), vitamin C (n=8, 20%) and substance use (n=7, 18%). Reasons given for abortion without clinical supervision ranged from perceived efficiency and desire for privacy, to structural issues including a lack of health insurance coverage, legal restrictions, denials of or mistreatment within clinical care, and cost. CONCLUSIONS These data highlight a high proportion of sampled TGE people who have attempted abortion without clinical supervision. This could reflect formidable barriers to facility-based abortion care as well as a strong desire for privacy and autonomy in the abortion process. Efforts are needed to connect TGE people with information on safe and effective methods of self-managed abortion and to dismantle barriers to clinical abortion care so that TGE people may freely choose a safe, effective abortion in either setting.
Collapse
Affiliation(s)
| | - Laura Fix
- Ibis Reproductive Health, Cambridge, Massachusetts, USA
| | | | | | - Jen Hastings
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, California, USA
| | - Ari Stoeffler
- Ibis Reproductive Health, Cambridge, Massachusetts, USA
| | - Eli A Goldberg
- Department of Family Medicine, The Robert Larner, M.D. College of Medicine at the University of Vermont, Burlington, Vermont, USA
| | - Mitchell R Lunn
- Department of Nephrology, Stanford University School of Medicine, Stanford, California, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
- The PRIDE Study, Stanford University, Stanford, California, USA
| | - Annesa Flentje
- The PRIDE Study, Stanford University, Stanford, California, USA
- Department of Community Health Systems, University of California San Francisco, San Francisco, California, USA
- Alliance Health Project, Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
| | - Matthew R Capriotti
- The PRIDE Study, Stanford University, Stanford, California, USA
- Department of Psychology, San Jose State University, San Jose, California, USA
| | - Micah E Lubensky
- The PRIDE Study, Stanford University, Stanford, California, USA
- Department of Community Health Systems, University of California San Francisco, San Francisco, California, USA
| | - Juno Obedin-Maliver
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
- The PRIDE Study, Stanford University, Stanford, California, USA
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, USA
| |
Collapse
|
5
|
Abortion experiences and preferences of transgender, nonbinary, and gender-expansive people in the United States. Am J Obstet Gynecol 2021; 224:376.e1-376.e11. [PMID: 32986990 PMCID: PMC7518170 DOI: 10.1016/j.ajog.2020.09.035] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/18/2020] [Accepted: 09/22/2020] [Indexed: 01/28/2023]
Abstract
Background Transgender, nonbinary, and gender-expansive people who were assigned female or intersex at birth experience pregnancy and have abortions. Scarce data have been published on individual abortion experiences or preferences of this understudied population. Objective This study aimed to fill existing evidence gaps on the abortion experiences and preferences of transgender, nonbinary, and gender-expansive people in the United States to inform policies and practices to improve access to and quality of abortion care for this population. Study Design In 2019, we recruited transgender, nonbinary, and gender-expansive people who were assigned female or intersex at birth at the age of ≥18 years from across the United States to participate in an online survey about sexual and reproductive health recruited through The Population Research in Identities and Disparities for Equality Study and online postings. We descriptively analyzed closed- and open-ended survey responses related to pregnancy history, abortion experiences, preferences for abortion method, recommendations to improve abortion care for transgender, nonbinary, and gender-expansive people, and respondent sociodemographic characteristics. Results Most of the 1694 respondents were <30 years of age. Respondents represented multiple gender identities and sexual orientations and resided across all 4 United States Census Regions. Overall, 210 respondents (12%) had ever been pregnant; these 210 reported 433 total pregnancies, of which 92 (21%) ended in abortion. For respondents’ most recent abortion, 41 (61%) were surgical, 23 (34%) were medication, and 3 (5%) were another method (primarily herbal). Most recent abortions took place at ≤9 weeks’ gestation (n=41, 61%). If they were to need an abortion today, respondents preferred medication abortion over surgical abortion in a 3:1 ratio (n=703 vs n=217), but 514 respondents (30%) did not know which method they would prefer. The reasons for medication abortion preference among the 703 respondents included a belief that it is the least invasive method (n=553, 79%) and the most private method (n=388, 55%). To improve accessibility and quality of abortion care for transgender, nonbinary, and gender-expansive patients, respondents most frequently recommended that abortion clinics adopt gender-neutral or gender-affirming intake forms, that providers use gender-neutral language, and that greater privacy be incorporated into the clinic. Conclusion These data contribute substantially to the evidence base on individual experiences of and preferences for abortion care for transgender, nonbinary, and gender-expansive people. Findings can be used to adapt abortion care to better include and affirm the experiences of this underserved population.
Collapse
|
6
|
Rodriguez-Wallberg KA, Häljestig J, Arver S, Johansson ALV, Lundberg FE. Sperm quality in transgender women before or after gender affirming hormone therapy-A prospective cohort study. Andrology 2021; 9:1773-1780. [PMID: 33683832 DOI: 10.1111/andr.12999] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/11/2021] [Accepted: 03/04/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Due to recent changes in the legal framework, access to fertility preservation (FP) for transgender individuals has opened up in several countries. In Sweden and the Nordic countries, fertility preservation for medical reasons is fully reimbursed as part of the established tax-funded healthcare services. As this issue is relatively new, procedures for FP have seldom been reported in the transgender patient population. The very limited literature has indicated that transgender women may have poorer sperm quality than cisgender men when assessing samples aimed at semen banking. OBJECTIVES To assess sperm quality parameters of semen samples provided for FP by transgender women before or after gender affirming hormone therapy (GAHT), and to compare sperm quality with a reference population of unscreened men defined by the World Health Organization (WHO). Additionally, we aimed to describe referral patterns over calendar time and estimate time from referral to semen cryopreservation. MATERIAL AND METHODS Prospective cohort study of 212 transgender women referred for FP to the Reproductive Medicine Clinic of Karolinska University Hospital, Sweden, between 2013 and 2018. Among 177 individuals that provided semen samples for cryopreservation, 16 had previously received GAHT. RESULTS Individuals with previous GAHT presented with significantly lower total sperm count than individuals without GAHT (p = 0.002). However, higher proportions of sperm abnormalities were also noted among individuals who had not undergone previous GAHT, compared to the WHO reference population (p < 0.001). Referrals of transgender women for FP increased over time. The median time from referral to semen cryopreservation was 27 days. CONCLUSIONS A high occurrence of sperm abnormalities was found in transgender women, especially among individuals who had previously received GAHT. The results underline the importance of thoroughly discussing parenthood options and FP with patients early after diagnosis and referring the patients for semen banking preferably before starting GAHT.
Collapse
Affiliation(s)
- Kenny A Rodriguez-Wallberg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Department of Reproductive Medicine, Division of Gynecology and Reproduction, Karolinska, University Hospital, Stockholm, Sweden
| | - Jakob Häljestig
- Department of Reproductive Medicine, Division of Gynecology and Reproduction, Karolinska, University Hospital, Stockholm, Sweden
| | - Stefan Arver
- Department of Medicine/Huddinge, Karolinska Institutet and ANOVA Andrology, Sexual Medicine, Trans Medicine Karolinska University Hospital, Stockholm, Sweden
| | - Anna L V Johansson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Frida E Lundberg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
7
|
Howe EG. People with Differences of Sexual Development: Can We Do Better? THE JOURNAL OF CLINICAL ETHICS 2021. [DOI: 10.1086/jce2021321003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
8
|
Voultsos P, Zymvragou CE, Karakasi MV, Pavlidis P. A qualitative study examining transgender people's attitudes towards having a child to whom they are genetically related and pursuing fertility treatments in Greece. BMC Public Health 2021; 21:378. [PMID: 33602164 PMCID: PMC7890100 DOI: 10.1186/s12889-021-10422-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 02/10/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Advances in biomedical technologies permit transgender individuals not only to achieve gender transition but also to experience parenthood. Little is known about this topic in Greece, which, although a traditionally conservative country, is changing at the legal level towards a greater recognition of transgender people's rights. This study aimed to investigate transgender people's attitudes towards having a child to whom they are genetically related and pursuing fertility treatments in Greece. METHODS This is a prospective qualitative study conducted with adult individuals who identified as transgender men or transgender women between April 2019 and March 2020. Individual in-depth qualitative interviews were conducted with 12 participants. The interviews were carried out in person and were digitally recorded and transcribed verbatim. We performed a thematic analysis of the data. RESULTS The thematic data analysis resulted in the identification of themes that represent key barriers to pursuing fertility preservation or the use of assisted reproductive technology. Six major themes were clearly present in the findings (lack of adequate information and counseling, worsening gender dysphoria, increased discrimination against transgender people due to the rise of extreme far-right populism, low parental self-efficacy, high costs, and a less-than-perfect legal framework). Moreover, diverse cases were examined, and minor themes, such as the symbolic value of the uterus and pregnancy, the relationship between the type of gender transition and willingness to pursue fertility treatments, and transgender people's adherence to heteronormative patterns in the context of reproduction, were identified. Various reasons for transgender people's differing degrees of desire for parenthood were identified. CONCLUSION Our findings demonstrated contextual factors as well as factors related to transgender people themselves as barriers to pursuing transgender parenthood. Most aspects of our findings are consistent with those of previous research. However, some aspects of our findings (regarding aggressive behaviors and economic instability) are specific to the context of Greece, which is characterized by the rise of extreme far-right populism due to the decade-long Greek economic crisis and a deeply conservative traditionalist background. In that regard, the participants highlighted the (perceived as) less-than-perfect Greek legislation on transgender people's rights as a barrier to transgender (biological) parenthood.
Collapse
Affiliation(s)
- P Voultsos
- Laboratory of Forensic Medicine & Toxicology (Medical Law and Ethics), School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, GR 54 124, Thessaloniki, Greece.
| | - C-E Zymvragou
- Laboratory of Forensic Medicine & Toxicology (Medical Law and Ethics), School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, GR 54 124, Thessaloniki, Greece
| | - M-V Karakasi
- Laboratory of Forensic Sciences, Democritus University of Thrace, School of Medicine, Dragana, GR 68100, Alexandroupolis, Greece
| | - P Pavlidis
- Laboratory of Forensic Sciences, Democritus University of Thrace, School of Medicine, Dragana, GR 68100, Alexandroupolis, Greece
| |
Collapse
|
9
|
Liu W, Schulster ML, Alukal JP, Najari BB. Fertility Preservation in Male to Female Transgender Patients. Urol Clin North Am 2019; 46:487-493. [PMID: 31582023 DOI: 10.1016/j.ucl.2019.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Gender dysphoria, or the incongruence between gender identification and sex assigned at birth with associated discomfort or distress, manifests in transgender patients, whose multifaceted care includes puberty suppression, cross-sex hormonal therapy, and gender-affirming surgery. Discussion of fertility preservation (FP) is paramount because many treatments compromise future fertility, and although transgender patients demonstrate desire for children, use of FP remains low for a plethora of reasons. In transgender women, established FP options include ejaculated sperm cryopreservation, electroejaculation, or testicular sperm extraction. Further research is needed regarding reproductive health and FP in transgender patients.
Collapse
Affiliation(s)
- Wen Liu
- Department of Urology, NYU Langone Medical Center, New York University School of Medicine, 222 East 41st Street, New York, NY 10017, USA
| | - Michael L Schulster
- Department of Urology, NYU Langone Medical Center, New York University School of Medicine, 222 East 41st Street, New York, NY 10017, USA
| | - Joseph P Alukal
- Department of Urology, New York Presbyterian Hospital, Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY 10032, USA
| | - Bobby B Najari
- Department of Urology, NYU Langone Medical Center, New York University School of Medicine, 222 East 41st Street, New York, NY 10017, USA; Department of Population Health, NYU Langone Medical Center, New York University School of Medicine, 227 East 30th Street, New York, NY 10016, USA.
| |
Collapse
|
10
|
Abstract
Hormonal therapy and gender-affirming surgeries in transgender people have known deleterious impacts on future fertility using one's own gametes. This review focuses on fertility preservation, including the effects of medical hormone treatment on fertility, available and experimental options of fertility preservation in transgender adults, including sperm cryopreservation for transwomen and oocyte cryopreservation for transmen, and options for prepubertal transgender adolescents, including testicular and ovarian tissue cryopreservation. Transgender patients continue to face barriers and receive infrequent counseling regarding fertility preservation. Physicians should ideally counsel and discuss fertility preservation options before transgender patients undergo hormone therapy of gender-affirmation surgery.
Collapse
Affiliation(s)
- Michael F Neblett
- Department of Gynecology and Obstetrics, Emory University, Emory University School of Medicine, Glenn Building, 4th Floor-412 B, 69 Jesse Hill Jr. Drive Southeast, Atlanta, GA 30303, USA
| | - Heather S Hipp
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Emory University School of Medicine, 550 Peachtree Street, Suite 1800, Atlanta, GA 30308, USA.
| |
Collapse
|
11
|
Ellis SA, Dalke L. Midwifery Care for Transfeminine Individuals. J Midwifery Womens Health 2019; 64:298-311. [DOI: 10.1111/jmwh.12957] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 12/17/2018] [Accepted: 12/31/2018] [Indexed: 11/29/2022]
Affiliation(s)
| | - Lily Dalke
- Planned Parenthood of New York City New York City New York
- NYC Health + Hospitals/Woodhull Brooklyn New York
| |
Collapse
|
12
|
Harris RM, Chan YM. Ethical issues with early genitoplasty in children with disorders of sex development. Curr Opin Endocrinol Diabetes Obes 2019; 26:49-53. [PMID: 30507698 DOI: 10.1097/med.0000000000000460] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Genitoplasty in children with disorders of sex development (DSD) is an ethically complex issue. From a surgical perspective, genitoplasty in early childhood is preferred because it is felt to be associated with improved tissue healing, decreased risk of complications, and reduced psychological impact of genital surgery. However, advocacy groups and recent ethics literature have argued for deferring genitoplasty until a child reaches decisional maturity. This article reviews these arguments using an ethical framework and discusses the application and challenges of recent disorders of sex development research. RECENT FINDINGS Recent ethics literature and advocacy groups have argued for deferring genitoplasty until a child reaches decisional maturity. As a counterpoint, urological societies have published arguments supporting the practice of early genitoplasty. Data from DSD research lends some guidance but also has a wide range of outcomes, which makes generalizability difficult. A retrospective, multicenter study of 21 individuals with congenital adrenal hyperplasia who underwent feminizing surgery showed no difference between cases and controls in social functioning, parent-child relationships, or sexual fulfillment. Ninety percent of patients thought genitoplasty should occur within the first year of life. In a study of 52 patients with 46,XY and 46,XX DSDs who underwent masculinizing genitoplasty, 57% thought their physical appearance was 'fair' or 'poor,' and problems with sexual function, urinary incontinence, and short penile length were common. SUMMARY Early genitoplasty in children with DSDs is ethically complex, and discordant results in DSD research makes generalizability difficult. There is unlikely to be a universal solution to the issue of early genitoplasty in children with DSDs; families must be supported while they weigh both parental decision-making and the objective of ensuring an open future for their child.
Collapse
Affiliation(s)
- Rebecca M Harris
- Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts, USA
| | | |
Collapse
|
13
|
Abstract
Puberty suppression is the reversible first step of endocrine medical treatment in transgender youth, and allows for two very important aspects of transgender management. Firstly, it buys the patient, family and their medical team time to fully evaluate the presence and persistence of gender dysphoria. Secondly, it successfully prevents the development of cis-gender unwanted secondary sexual characteristics. The latter, when present, almost certainly increase the burden of psychological co-morbidity for any transgender person. This management is modelled from treatment of gonadotropin-dependent precious puberty, with use of GnRH agonists at its core. With the increasing number of transgender youth treated, and the changing demographics of patients seeking medical care, providers are faced with the decision to start puberty blockade at younger ages than previous decades. This article will review the rationale behind puberty blockade for transgender children, the providers' options for achieving this goal, the emerging literature for potential adverse effects on such an approach, as well as identify directions of potential future research.
Collapse
Affiliation(s)
- Leonidas Panagiotakopoulos
- Department of Pediatrics, Division of Pediatric Endocrinology, Emory University, 2nd floor, rm 456, 2015 Uppergate Drive NE, Atlanta, GA, 30322, USA.
| |
Collapse
|
14
|
Rowlands S, Amy JJ. Involuntary sterilisation: we still need to guard against it. BMJ SEXUAL & REPRODUCTIVE HEALTH 2018; 44:bmjsrh-2018-200119. [PMID: 29997236 DOI: 10.1136/bmjsrh-2018-200119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 05/23/2018] [Accepted: 06/19/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Sam Rowlands
- Centre of Postgraduate Medical Research and Education, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Jean-Jacques Amy
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| |
Collapse
|
15
|
Amy JJ, Rowlands S. Legalised non-consensual sterilisation - eugenics put into practice before 1945, and the aftermath. Part 1: USA, Japan, Canada and Mexico. EUR J CONTRACEP REPR 2018; 23:121-129. [PMID: 29624082 DOI: 10.1080/13625187.2018.1450973] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
In the late 19th century, eugenics, a pseudo-scientific doctrine based on an erroneous interpretation of the laws of heredity, swept across the industrialised world. Academics and other influential figures who promoted it convinced political stakeholders to enact laws authorising the sterilisation of people seen as 'social misfits'. The earliest sterilisation Act was enforced in Indiana, in 1907; most states in the USA followed suit and so did several countries, with dissimilar political regimes. The end of the Second World War saw the suspension of Nazi legislation in Germany, including that regulating coerced sterilisation. The year 1945 should have been the endpoint of these inhuman practices but, in the early post-war period, the existing sterilisation Acts were suspended solely in Germany and Austria. Only much later did certain countries concerned - not Japan so far - officially acknowledge the human rights violations committed, issue apologies and develop reparation schemes for the victims' benefit.
Collapse
Affiliation(s)
- Jean-Jacques Amy
- a Faculty of Medicine & Pharmacy , Vrije Universiteit Brussel , Brussels , Belgium
| | - Sam Rowlands
- b Faculty of Health & Social Sciences , Bournemouth University , Bournemouth , UK
| |
Collapse
|