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Asseler JD, de Nie I, van Rooij FB, Steensma TD, Mosterd D, Verhoeven MO, Goddijn M, Huirne JAF, van Mello NM. Transgender persons' view on previous fertility decision-making and current infertility: a qualitative study. Hum Reprod 2024; 39:2032-2042. [PMID: 39008827 PMCID: PMC11373325 DOI: 10.1093/humrep/deae155] [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: 08/22/2023] [Revised: 06/13/2024] [Indexed: 07/17/2024] Open
Abstract
STUDY QUESTION How do adult transgender and gender diverse (TGD) people, who are infertile due to prior gender-affirming treatment, view their current infertility and their reproductive decisions made in the past? SUMMARY ANSWER In a time where sterilization was mandatory, transgender adolescents prioritized gender-affirming treatment over their future fertility and would make the same choice today despite emotional challenges related to infertility experienced by some. WHAT IS KNOWN ALREADY Under transgender law in the Netherlands, sterilization was required for legal gender recognition until 2014, resulting in permanent infertility. The long-term consequences of this iatrogenic infertility in transgender adolescents who have now reached adulthood remain underexplored. STUDY DESIGN, SIZE, DURATION Qualitative study design based on 21 in-depth one-on-one semi-structured interviews. PARTICIPANTS/MATERIALS, SETTING, METHODS TGD people in a stage of life where family planning may be a current topic were eligible for participation. They all received gender-affirming treatment in adolescence prior to the legislation change in 2014. A purposeful sampling technique was used from participants of another ongoing study. Eleven people assigned female at birth and ten people assigned male at birth were included. Interview transcripts were thematically analysed using a modified version of Braun and Clarke's six steps theory. MAIN RESULTS AND THE ROLE OF CHANCE Six main themes were generated: (i) personal considerations regarding fertility and fertility preservation in the past; (ii) external considerations regarding fertility and fertility preservation in the past; (iii) current vision on past considerations and decisions; (iv) Current experiences and coping with infertility; (v) future family building; (vi) advice regarding fertility and fertility preservation decision-making. LIMITATIONS, REASONS FOR CAUTION Selection, recall, and choice supportive bias may play a role in interpreting our results. WIDER IMPLICATIONS OF THE FINDINGS This study highlights the importance of tailored counselling and comprehensive information on fertility preservation for transgender individuals, especially adolescents, undergoing gender-affirming treatment. STUDY FUNDING/COMPETING INTEREST(S) N/A. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- J D Asseler
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Centre of Expertise on Gender Dysphoria, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - I de Nie
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Centre of Expertise on Gender Dysphoria, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
- Department of Endocrinology, Amsterdam UMC, Amsterdam, The Netherlands
| | - F B van Rooij
- Research Institute Child Development and Education, Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - T D Steensma
- Centre of Expertise on Gender Dysphoria, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam UMC, Amsterdam, The Netherlands
| | - D Mosterd
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M O Verhoeven
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - M Goddijn
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
- Centre for Reproductive Medicine, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
| | - J A F Huirne
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - N M van Mello
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Centre of Expertise on Gender Dysphoria, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
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White J, Jackson A, Druce I, Gale J. Oocyte cryopreservation and reciprocal in vitro fertilization in a transgender man on long term testosterone gender-affirming hormone therapy: a case report. F S Rep 2024; 5:111-113. [PMID: 38524208 PMCID: PMC10958692 DOI: 10.1016/j.xfre.2023.11.004] [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: 05/03/2023] [Revised: 10/21/2023] [Accepted: 11/06/2023] [Indexed: 03/26/2024] Open
Abstract
Objective To report a successful case of oocyte cryopreservation and subsequent in vitro fertilization (IVF) in a transgender male receiving continued testosterone gender-affirming hormone therapy, followed by reciprocal embryo transfer (ET). Design A case report of a rare case of fertility preservation in a transgender man with concomitant use of testosterone therapy for 4 years before and during ovarian stimulation. Setting Private fertility clinic with university affiliation. Patients A 26-year-old transgender man undergoing oocyte cryopreservation before gender-affirming surgery. Interventions Fertility preservation using oocyte cryopreservation and IVF with reciprocal fresh ET into a cisfemale partner. Main Outcome Measures Successful oocyte cryopreservation, oocyte thawing, and reciprocal IVF cycle. Results Oocyte cryopreservation of 29 mature oocytes. Sixteen mature oocytes survived the thaw, and 12 were fertilized with intracytoplasmic sperm injection. A fresh ET of an advanced blastocyst resulted in a clinical pregnancy and live birth. Conclusions Fertility preservation with oocyte cryopreservation or IVF with embryo cryopreservation is feasible for patients on continued long-term testosterone gender-affirming therapy. Future studies on egg quality and reproductive outcomes are required. Our case report demonstrates a promising outcome in this patient population.
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Affiliation(s)
- Justin White
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Fertilty Centre, Ottawa, Ontario, Canada
| | - Aaron Jackson
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Fertilty Centre, Ottawa, Ontario, Canada
| | - Irena Druce
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Jenna Gale
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Fertilty Centre, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Saadat M, Keramat A, Jahanfar S, Nazari AM, Ranjbar H, Motaghi Z. Barriers and Facilitators to Accessing Sexual and Reproductive Health Services Among Transgender People: A Meta-Synthesis. INTERNATIONAL JOURNAL OF SOCIAL DETERMINANTS OF HEALTH AND HEALTH SERVICES 2024; 54:40-51. [PMID: 37470127 DOI: 10.1177/27551938231187863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
The availability and accessibility of sexual and reproductive health (SRH) services for transgender individuals are crucial. This population is deprived of health care due to rejection, stigma, gender-based discrimination, confidentiality, and violence. This review attempts to provide readers with an account of the fundamental problems that the transgender population faces regarding experiences of SRH. This meta-synthesis review applied the Social-Ecological Model (SEM) to address trans individuals' SRH factors. The databases were searched using "SRH" and "transgender" keywords. Fifty studies were finally selected. All studies were qualitative, including 36 semi-structured/ in-depth interviews, two focus group studies, and 12 interviews and focus group studies. The Social-Ecological Model application illustrates the impact of individual, interpersonal, institutional, and social factors on the condition of SRH among transgender individuals. This meta-synthesis reinforces multiple levels of factors that influence the SRH of transgender individuals. These include limited information, lack of awareness, low socioeconomic status, stigma and discrimination, and social deprivation. Interventions are urgently needed to provide better sexual and reproductive well-being for transgender individuals.
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Affiliation(s)
- Mina Saadat
- Student Research Committee, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Afsaneh Keramat
- Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Shayesteh Jahanfar
- Tufts School of Medicine, Department of Public Health and Community Medicine, Boston, MA, USA
| | - Ali Mohammad Nazari
- School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Hadi Ranjbar
- Mental Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Motaghi
- School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
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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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Asseler JD, Knieriem J, Huirne JA, Goddijn M, Verhoeven MO, van Mello NM. Outcomes of oocyte vitrification in trans masculine individuals. Reprod Biomed Online 2023; 47:94-101. [PMID: 37095040 DOI: 10.1016/j.rbmo.2023.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/17/2023] [Accepted: 03/08/2023] [Indexed: 03/16/2023]
Abstract
RESEARCH QUESTION What are the outcomes and experiences of oocyte vitrification treatment in trans masculine individuals (TMI) before and after testosterone use? DESIGN This retrospective cohort study was conducted at the Amsterdam UMC in the Netherlands between January 2017 and June 2021. The TMI who had completed an oocyte vitrification treatment were consecutively approached for participation. Informed consent was provided by 24 individuals. Participants (n = 7) who initiated testosterone therapy were advised to stop 3 months before stimulation. Demographic characteristics and oocyte vitrification treatment data were retrieved from medical records. Evaluation of the treatment was collected via an online questionnaire. RESULTS The median age of participants was 22.3 years (interquartile range 21.1-26.0) and mean body mass index was 23.0 kg/m2 (SD 3.2). After ovarian hyperstimulation, a mean of 20 oocytes (SD 7) were retrieved and a mean of 17 oocytes (SD 6) could be vitrified. Aside from a lower cumulative FSH dose, there were no significant differences between the prior testosterone users and testosterone naïve TMI. The overall satisfaction of oocyte vitrification treatment in participants was high. Hormone injections were considered the most strenuous part of treatment by 29% of participants, closely followed by oocyte retrieval (25%). CONCLUSIONS No difference in response to ovarian stimulation was found for oocyte vitrification treatment between the prior testosterone users and testosterone naïve TMI. The questionnaire identified hormone injections as the most burdensome aspect of oocyte vitrification treatment. This information can be used to improve gender sensitive fertility counselling and fertility treatment strategies.
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Affiliation(s)
- Joyce D Asseler
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Obstetrics and Gynaecology, De Boelelaan 1117, Amsterdam, the Netherlands.; Amsterdam UMC, Centre of Expertise on Gender Dysphoria, Amsterdam, The Netherlands.; Amsterdam Reproduction and Development research institute, Amsterdam, The Netherlands..
| | - Julie Knieriem
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Obstetrics and Gynaecology, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Judith Af Huirne
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Obstetrics and Gynaecology, De Boelelaan 1117, Amsterdam, the Netherlands.; Amsterdam Reproduction and Development research institute, Amsterdam, The Netherlands
| | - Mariette Goddijn
- Amsterdam UMC location University of Amsterdam, Department of Obstetrics and Gynaecology, Meibergdreef 9, Amsterdam, The Netherlands.; Amsterdam Reproduction and Development research institute, Amsterdam, The Netherlands
| | - Marieke O Verhoeven
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Obstetrics and Gynaecology, De Boelelaan 1117, Amsterdam, the Netherlands.; Amsterdam Reproduction and Development research institute, Amsterdam, The Netherlands
| | - Norah M van Mello
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Obstetrics and Gynaecology, De Boelelaan 1117, Amsterdam, the Netherlands.; Amsterdam UMC, Centre of Expertise on Gender Dysphoria, Amsterdam, The Netherlands.; Amsterdam Reproduction and Development research institute, Amsterdam, The Netherlands
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6
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Taylor J, Vullikanti M, Nelamangala SL, Boguszewski KE, Marshall MF. Sexual & reproductive health information on minor consent forms for pubertal suppression and gender affirming hormones. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1071212. [PMID: 37152482 PMCID: PMC10154520 DOI: 10.3389/frph.2023.1071212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 04/03/2023] [Indexed: 05/09/2023] Open
Abstract
Introduction Transgender and Nonbinary (TNB) youth need specialized sexual and reproductive health (SRH) information and counseling. One avenue for providing this information is the use of informed consent documents before initiating pubertal suppression (PS) and/or gender-affirming hormones (GAHs). This study aims to compare the type and amount of SRH information included on informed consent documents used across clinical sites providing PS and GAH to youth. Methods As part of a larger, IRB-approved survey on informed consent, providers of gender-related care to youth uploaded informed consent forms used in clinical practice. Publicly available forms were also included in analysis. Content analysis of these forms was undertaken using published clinical guidelines to inform coding and reflect the SRH implications of starting PS and GAH. Results 21 unique consent documents were included in the content analysis (PS = 7, Masculinizing = 7, Feminizing = 7). SRH information on consent documents fell into 4 broad categories: (1) changes in sexual organs and functioning; (2) pregnancy and fertility information; (3) cancer risk; and (4) sexually transmitted infections. Forms varied considerably in the level of detail included about these SRH topics and most forms included implicit or explicit acknowledgement of the uncertainty that exists around certain SRH outcomes for TNB youth. Conclusions There was substantial variability in both SRH content and context across consent forms. The role of consent forms in fostering TNB youth's understanding of complex SHR information when initiating PS and GAHs needs further clarification and development. Future research should focus on ways to ensure provision of adequate SRH information for TNB youth.
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Affiliation(s)
- Julia Taylor
- Center for Health Humanities & Ethics, Univerisity of Virginia, Charlottesville, VA, United States
- School of Medicine, Department of Pediatrics, University of Virginia, Charlottesville, VA, United States
| | - Meesha Vullikanti
- Center for Health Humanities & Ethics, Univerisity of Virginia, Charlottesville, VA, United States
| | - Samhita L. Nelamangala
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Katherine E. Boguszewski
- School of Medicine, Department of Pediatrics, University of Virginia, Charlottesville, VA, United States
| | - Mary Faith Marshall
- Center for Health Humanities & Ethics, Univerisity of Virginia, Charlottesville, VA, United States
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Lambert A, Pratt A, Conard LAE, Grigg Dean E, Page E, Vaughn LM, Lipstein EA. Supporting Gender-Related Medical Decision Making for Transgender and Gender-Diverse Individuals: A Scoping Review. Transgend Health 2023; 8:113-123. [PMID: 37013094 PMCID: PMC10066778 DOI: 10.1089/trgh.2021.0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose Transgender and gender-diverse (TGD) individuals and their families face numerous challenging decisions. To better understand their decision processes, we conducted a scoping review of the existing literature and of decision-support tools in use at pediatric gender-care clinics. Methods We searched PubMed, EMBASE, Scopus CINAHL, PsychINFO, and EBM Reviews for studies that were original research focused on decisions, decision making, or decision support for TGD individuals and/or their families. All studies were reviewed for inclusion by at least two researchers. Additionally, we reviewed clinical tools used to support decision making by TGD youth and their families. Results We retrieved 3306 articles. Thirty-two met criteria for data extraction. Studies focused on three major decisions: gender-confirming surgery, fertility preservation, and gender-affirming hormone therapy. Several themes that cut across clinical topics emerged: decision-making processes, decision-making roles, and sources of decision support. Only three articles focused on decision-support interventions, two of which discussed development of support tools and one evaluated a class designed to help with surgical decision making. None of the clinical tools reviewed met criteria for a decision aid. Conclusions There is a dearth of studies related to decision support interventions, an absence validated by the resources currently in clinical use. This scoping review suggests an opportunity for the development of tools to aid in the decision-making processes for TGD youth and their families.
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Affiliation(s)
- Amy Lambert
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Ashli Pratt
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Lee Ann E. Conard
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Elaine Grigg Dean
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Erica Page
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Lisa M. Vaughn
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Ellen A. Lipstein
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Albar M, Koziarz A, McMahon E, Chan C, Liu K. Timing of testosterone discontinuation and assisted reproductive technology outcomes in transgender patients: a cohort study. F S Rep 2023; 4:55-60. [PMID: 36959967 PMCID: PMC10028470 DOI: 10.1016/j.xfre.2023.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 01/12/2023] [Accepted: 01/17/2023] [Indexed: 01/22/2023] Open
Abstract
Objective To determine if there is an association between the timing of testosterone discontinuation and assisted reproductive technology (ART) outcomes. Design Retrospectivse cohort study. Setting Single academic center. Patients We included consecutive transgender patients seeking fertility preservation between October 2019 and April 2021. Patients who identified as transgender on androgens for >1 month on presentation were included. Interventions None. Main outcome measures A linear regression model was used to evaluate the effect of testosterone discontinuation duration on the number of mature oocytes retrieved. Results Eighteen patients (mean age 27.7 [SD 5.2] years, mean body mass index 27.3 [SD 4.6] kg/m2, mean antimüllerian hormone 27.2 [SD 11.8], median antral follicle count 20 [interquartile range (IQR) 14-32]) were included in the analysis. No patient underwent transition-related surgery (eg, oophorectomy, hysterectomy). None of the patients were previously pregnant. Mean time o,n testosterone was 44 (SD 29.6) months. The median time off testosterone until the start of ovarian stimulation was 7.7 weeks (IQR 4.3-20.7). All patients underwent oocyte cryopreservation except one who had embryo cryopreservation. The median total number of oocytes was 11 (IQR 7-14). The median number of mature oocytes was 7.5 (IQR 5-12) oocytes. The univariate regression model evaluating the duration of time off testosterone before ART demonstrated no significant association with the outcome of mature oocytes (regression coefficient, 0.19; 95% confidence interval, -0.13 to 0.50). Conclusion In a retrospective analysis of transgender patients recently on testosterone undergoing ART, no association was detected between the timing of testosterone cessation and the number of mature oocytes.
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Affiliation(s)
- Mohammad Albar
- Department of Obstetrics and Gynaecology, University of King Abdulaziz, Jeddah, Saudi Arabia
| | - Alex Koziarz
- Department of Radiology, McMaster University, Hamilton, Ontario, Canada
| | - Eileen McMahon
- Hannam Fertility Centre, Toronto, Ontario, Canada
- Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada
| | - Crystal Chan
- Markham Fertility Centre, Toronto, Ontario, Canada
| | - Kimberly Liu
- Mount Sinai Fertility, Toronto, Ontario, Canada
- Reprint requests: Kimberly Liu, M.D., M.S.L., Division of Reproductive Endocrinology and Infertility, Mount Sinai Fertility, University of Toronto, 250 Dundas Street West, Suite 700, Ontario, Canada.
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Coleman E, Radix AE, Bouman WP, Brown GR, de Vries ALC, Deutsch MB, Ettner R, Fraser L, Goodman M, Green J, Hancock AB, Johnson TW, Karasic DH, Knudson GA, Leibowitz SF, Meyer-Bahlburg HFL, Monstrey SJ, Motmans J, Nahata L, Nieder TO, Reisner SL, Richards C, Schechter LS, Tangpricha V, Tishelman AC, Van Trotsenburg MAA, Winter S, Ducheny K, Adams NJ, Adrián TM, Allen LR, Azul D, Bagga H, Başar K, Bathory DS, Belinky JJ, Berg DR, Berli JU, Bluebond-Langner RO, Bouman MB, Bowers ML, Brassard PJ, Byrne J, Capitán L, Cargill CJ, Carswell JM, Chang SC, Chelvakumar G, Corneil T, Dalke KB, De Cuypere G, de Vries E, Den Heijer M, Devor AH, Dhejne C, D'Marco A, Edmiston EK, Edwards-Leeper L, Ehrbar R, Ehrensaft D, Eisfeld J, Elaut E, Erickson-Schroth L, Feldman JL, Fisher AD, Garcia MM, Gijs L, Green SE, Hall BP, Hardy TLD, Irwig MS, Jacobs LA, Janssen AC, Johnson K, Klink DT, Kreukels BPC, Kuper LE, Kvach EJ, Malouf MA, Massey R, Mazur T, McLachlan C, Morrison SD, Mosser SW, Neira PM, Nygren U, Oates JM, Obedin-Maliver J, Pagkalos G, Patton J, Phanuphak N, Rachlin K, Reed T, Rider GN, Ristori J, Robbins-Cherry S, Roberts SA, Rodriguez-Wallberg KA, Rosenthal SM, Sabir K, Safer JD, Scheim AI, Seal LJ, Sehoole TJ, Spencer K, St Amand C, Steensma TD, Strang JF, Taylor GB, Tilleman K, T'Sjoen GG, Vala LN, Van Mello NM, Veale JF, Vencill JA, Vincent B, Wesp LM, West MA, Arcelus J. Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2022; 23:S1-S259. [PMID: 36238954 PMCID: PMC9553112 DOI: 10.1080/26895269.2022.2100644] [Citation(s) in RCA: 662] [Impact Index Per Article: 331.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Background: Transgender healthcare is a rapidly evolving interdisciplinary field. In the last decade, there has been an unprecedented increase in the number and visibility of transgender and gender diverse (TGD) people seeking support and gender-affirming medical treatment in parallel with a significant rise in the scientific literature in this area. The World Professional Association for Transgender Health (WPATH) is an international, multidisciplinary, professional association whose mission is to promote evidence-based care, education, research, public policy, and respect in transgender health. One of the main functions of WPATH is to promote the highest standards of health care for TGD people through the Standards of Care (SOC). The SOC was initially developed in 1979 and the last version (SOC-7) was published in 2012. In view of the increasing scientific evidence, WPATH commissioned a new version of the Standards of Care, the SOC-8. Aim: The overall goal of SOC-8 is to provide health care professionals (HCPs) with clinical guidance to assist TGD people in accessing safe and effective pathways to achieving lasting personal comfort with their gendered selves with the aim of optimizing their overall physical health, psychological well-being, and self-fulfillment. Methods: The SOC-8 is based on the best available science and expert professional consensus in transgender health. International professionals and stakeholders were selected to serve on the SOC-8 committee. Recommendation statements were developed based on data derived from independent systematic literature reviews, where available, background reviews and expert opinions. Grading of recommendations was based on the available evidence supporting interventions, a discussion of risks and harms, as well as the feasibility and acceptability within different contexts and country settings. Results: A total of 18 chapters were developed as part of the SOC-8. They contain recommendations for health care professionals who provide care and treatment for TGD people. Each of the recommendations is followed by explanatory text with relevant references. General areas related to transgender health are covered in the chapters Terminology, Global Applicability, Population Estimates, and Education. The chapters developed for the diverse population of TGD people include Assessment of Adults, Adolescents, Children, Nonbinary, Eunuchs, and Intersex Individuals, and people living in Institutional Environments. Finally, the chapters related to gender-affirming treatment are Hormone Therapy, Surgery and Postoperative Care, Voice and Communication, Primary Care, Reproductive Health, Sexual Health, and Mental Health. Conclusions: The SOC-8 guidelines are intended to be flexible to meet the diverse health care needs of TGD people globally. While adaptable, they offer standards for promoting optimal health care and guidance for the treatment of people experiencing gender incongruence. As in all previous versions of the SOC, the criteria set forth in this document for gender-affirming medical interventions are clinical guidelines; individual health care professionals and programs may modify these in consultation with the TGD person.
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Affiliation(s)
- E Coleman
- Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - A E Radix
- Callen-Lorde Community Health Center, New York, NY, USA
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - W P Bouman
- Nottingham Centre for Transgender Health, Nottingham, UK
- School of Medicine, University of Nottingham, Nottingham, UK
| | - G R Brown
- James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
- James H. Quillen VAMC, Johnson City, TN, USA
| | - A L C de Vries
- Department of Child and Adolescent Psychiatry, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M B Deutsch
- Department of Family & Community Medicine, University of California-San Francisco, San Francisco, CA, USA
- UCSF Gender Affirming Health Program, San Francisco, CA, USA
| | - R Ettner
- New Health Foundation Worldwide, Evanston, IL, USA
- Weiss Memorial Hospital, Chicago, IL, USA
| | - L Fraser
- Independent Practice, San Francisco, CA, USA
| | - M Goodman
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - J Green
- Independent Scholar, Vancouver, WA, USA
| | - A B Hancock
- The George Washington University, Washington, DC, USA
| | - T W Johnson
- Department of Anthropology, California State University, Chico, CA, USA
| | - D H Karasic
- University of California San Francisco, San Francisco, CA, USA
- Independent Practice at dankarasic.com
| | - G A Knudson
- University of British Columbia, Vancouver, Canada
- Vancouver Coastal Health, Vancouver, Canada
| | - S F Leibowitz
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - H F L Meyer-Bahlburg
- New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, Columbia University, New York, NY, USA
| | | | - J Motmans
- Transgender Infopunt, Ghent University Hospital, Gent, Belgium
- Centre for Research on Culture and Gender, Ghent University, Gent, Belgium
| | - L Nahata
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
- Endocrinology and Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - T O Nieder
- University Medical Center Hamburg-Eppendorf, Interdisciplinary Transgender Health Care Center Hamburg, Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, Hamburg, Germany
| | - S L Reisner
- Harvard Medical School, Boston, MA, USA
- Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - C Richards
- Regents University London, UK
- Tavistock and Portman NHS Foundation Trust, London, UK
| | | | - V Tangpricha
- Division of Endocrinology, Metabolism & Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Atlanta VA Medical Center, Decatur, GA, USA
| | - A C Tishelman
- Boston College, Department of Psychology and Neuroscience, Chestnut Hill, MA, USA
| | - M A A Van Trotsenburg
- Bureau GenderPRO, Vienna, Austria
- University Hospital Lilienfeld-St. Pölten, St. Pölten, Austria
| | - S Winter
- School of Population Health, Curtin University, Perth, WA, Australia
| | - K Ducheny
- Howard Brown Health, Chicago, IL, USA
| | - N J Adams
- University of Toronto, Ontario Institute for Studies in Education, Toronto, Canada
- Transgender Professional Association for Transgender Health (TPATH)
| | - T M Adrián
- Asamblea Nacional de Venezuela, Caracas, Venezuela
- Diverlex Diversidad e Igualdad a Través de la Ley, Caracas, Venezuela
| | - L R Allen
- University of Nevada, Las Vegas, NV, USA
| | - D Azul
- La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - H Bagga
- Monash Health Gender Clinic, Melbourne, Victoria, Australia
- Monash University, Melbourne, Victoria, Australia
| | - K Başar
- Department of Psychiatry, Hacettepe University, Ankara, Turkey
| | - D S Bathory
- Independent Practice at Bathory International PLLC, Winston-Salem, NC, USA
| | - J J Belinky
- Durand Hospital, Guemes Clinic and Urological Center, Buenos Aires, Argentina
| | - D R Berg
- National Center for Gender Spectrum Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - J U Berli
- Oregon Health & Science University, Portland, OR, USA
| | - R O Bluebond-Langner
- NYU Langone Health, New York, NY, USA
- Hansjörg Wyss Department of Plastic Surgery, New York, NY, USA
| | - M-B Bouman
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Plastic Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - M L Bowers
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mills-Peninsula Medical Center, Burlingame, CA, USA
| | - P J Brassard
- GrS Montreal, Complexe CMC, Montreal, Quebec, Canada
- Université de Montreal, Quebec, Canada
| | - J Byrne
- University of Waikato/Te Whare Wānanga o Waikato, Hamilton/Kirikiriroa, New Zealand/Aotearoa
| | - L Capitán
- The Facialteam Group, Marbella International Hospital, Marbella, Spain
| | | | - J M Carswell
- Harvard Medical School, Boston, MA, USA
- Boston's Children's Hospital, Boston, MA, USA
| | - S C Chang
- Independent Practice, Oakland, CA, USA
| | - G Chelvakumar
- Nationwide Children's Hospital, Columbus, OH, USA
- The Ohio State University, College of Medicine, Columbus, OH, USA
| | - T Corneil
- School of Population & Public Health, University of British Columbia, Vancouver, BC, Canada
| | - K B Dalke
- Penn State Health, PA, USA
- Penn State College of Medicine, Hershey, PA, USA
| | - G De Cuypere
- Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium
| | - E de Vries
- Nelson Mandela University, Gqeberha, South Africa
- University of Cape Town, Cape Town, South Africa
| | - M Den Heijer
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Endocrinology, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - A H Devor
- University of Victoria, Victoria, BC, Canada
| | - C Dhejne
- ANOVA, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - A D'Marco
- UCTRANS-United Caribbean Trans Network, Nassau, The Bahamas
- D M A R C O Organization, Nassau, The Bahamas
| | - E K Edmiston
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - L Edwards-Leeper
- Pacific University, Hillsboro, OR, USA
- Independent Practice, Beaverton, OR, USA
| | - R Ehrbar
- Whitman Walker Health, Washington, DC, USA
- Independent Practice, Maryland, USA
| | - D Ehrensaft
- University of California San Francisco, San Francisco, CA, USA
| | - J Eisfeld
- Transvisie, Utrecht, The Netherlands
| | - E Elaut
- Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium
- Department of Clinical Experimental and Health Psychology, Ghent University, Gent, Belgium
| | - L Erickson-Schroth
- The Jed Foundation, New York, NY, USA
- Hetrick-Martin Institute, New York, NY, USA
| | - J L Feldman
- Institute for Sexual and Gender Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - A D Fisher
- Andrology, Women Endocrinology and Gender Incongruence, Careggi University Hospital, Florence, Italy
| | - M M Garcia
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Departments of Urology and Anatomy, University of California San Francisco, San Francisco, CA, USA
| | - L Gijs
- Institute of Family and Sexuality Studies, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | | | - B P Hall
- Duke University Medical Center, Durham, NC, USA
- Duke Adult Gender Medicine Clinic, Durham, NC, USA
| | - T L D Hardy
- Alberta Health Services, Edmonton, Alberta, Canada
- MacEwan University, Edmonton, Alberta, Canada
| | - M S Irwig
- Harvard Medical School, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - A C Janssen
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - K Johnson
- RMIT University, Melbourne, Australia
- University of Brighton, Brighton, UK
| | - D T Klink
- Department of Pediatrics, Division of Pediatric Endocrinology, Ghent University Hospital, Gent, Belgium
- Division of Pediatric Endocrinology and Diabetes, ZNA Queen Paola Children's Hospital, Antwerp, Belgium
| | - B P C Kreukels
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - L E Kuper
- Department of Psychiatry, Southwestern Medical Center, University of Texas, Dallas, TX, USA
- Department of Endocrinology, Children's Health, Dallas, TX, USA
| | - E J Kvach
- Denver Health, Denver, CO, USA
- University of Colorado School of Medicine, Aurora, CO, USA
| | - M A Malouf
- Malouf Counseling and Consulting, Baltimore, MD, USA
| | - R Massey
- WPATH Global Education Institute
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - T Mazur
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- John R. Oishei Children's Hospital, Buffalo, NY, USA
| | - C McLachlan
- Professional Association for Transgender Health, South Africa
- Gender DynamiX, Cape Town, South Africa
| | - S D Morrison
- Division of Plastic Surgery, Seattle Children's Hospital, Seattle, WA, USA
- Division of Plastic Surgery, Department of Surgery, University of Washington Medical Center, Seattle, WA, USA
| | - S W Mosser
- Gender Confirmation Center, San Francisco, CA, USA
- Saint Francis Memorial Hospital, San Francisco, CA, USA
| | - P M Neira
- Johns Hopkins Center for Transgender Health, Baltimore, MD, USA
- Johns Hopkins Medicine Office of Diversity, Inclusion and Health Equity, Baltimore, MD, USA
| | - U Nygren
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Speech and Language Pathology, Medical Unit, Karolinska University Hospital, Stockholm, Sweden
| | - J M Oates
- La Trobe University, Melbourne, Australia
- Melbourne Voice Analysis Centre, East Melbourne, Australia
| | - J Obedin-Maliver
- Stanford University School of Medicine, Department of Obstetrics and Gynecology, Palo Alto, CA, USA
- Department of Epidemiology and Population Health, Stanford, CA, USA
| | - G Pagkalos
- Independent PracticeThessaloniki, Greece
- Military Community Mental Health Center, 424 General Military Training Hospital, Thessaloniki, Greece
| | - J Patton
- Talkspace, New York, NY, USA
- CytiPsychological LLC, San Diego, CA, USA
| | - N Phanuphak
- Institute of HIV Research and Innovation, Bangkok, Thailand
| | - K Rachlin
- Independent Practice, New York, NY, USA
| | - T Reed
- Gender Identity Research and Education Society, Leatherhead, UK
| | - G N Rider
- National Center for Gender Spectrum Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - J Ristori
- Andrology, Women Endocrinology and Gender Incongruence, Careggi University Hospital, Florence, Italy
| | | | - S A Roberts
- Harvard Medical School, Boston, MA, USA
- Division of Endocrinology, Boston's Children's Hospital, Boston, MA, USA
| | - K A Rodriguez-Wallberg
- Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | - S M Rosenthal
- Division of Pediatric Endocrinology, UCSF, San Francisco, CA, USA
- UCSF Child and Adolescent Gender Center
| | - K Sabir
- FtM Phoenix Group, Krasnodar Krai, Russia
| | - J D Safer
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mount Sinai Center for Transgender Medicine and Surgery, New York, NY, USA
| | - A I Scheim
- Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
- Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, Ontario, Canada
| | - L J Seal
- Tavistock and Portman NHS Foundation Trust, London, UK
- St George's University Hospitals NHS Foundation Trust, London, UK
| | | | - K Spencer
- National Center for Gender Spectrum Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - C St Amand
- University of Houston, Houston, TX, USA
- Mayo Clinic, Rochester, MN, USA
| | - T D Steensma
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - J F Strang
- Children's National Hospital, Washington, DC, USA
- George Washington University School of Medicine, Washington, DC, USA
| | - G B Taylor
- Atrium Health Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Charlotte, NC, USA
| | - K Tilleman
- Department for Reproductive Medicine, Ghent University Hospital, Gent, Belgium
| | - G G T'Sjoen
- Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium
- Department of Endocrinology, Ghent University Hospital, Gent, Belgium
| | - L N Vala
- Independent Practice, Campbell, CA, USA
| | - N M Van Mello
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - J F Veale
- School of Psychology, University of Waikato/Te Whare Wānanga o Waikato, Hamilton/Kirikiriroa, New Zealand/Aotearoa
| | - J A Vencill
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - B Vincent
- Trans Learning Partnership at https://spectra-london.org.uk/trans-learning-partnership, UK
| | - L M Wesp
- College of Nursing, University of Wisconsin MilwaukeeMilwaukee, WI, USA
- Health Connections Inc., Glendale, WI, USA
| | - M A West
- North Memorial Health Hospital, Robbinsdale, MN, USA
- University of Minnesota, Minneapolis, MN, USA
| | - J Arcelus
- School of Medicine, University of Nottingham, Nottingham, UK
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
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10
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Park SU, Sachdev D, Dolitsky S, Bridgeman M, Sauer MV, Bachmann G, Hutchinson-Colas J. Fertility preservation in transgender men and the need for uniform, comprehensive counseling. F S Rep 2022; 3:253-263. [PMID: 36212567 PMCID: PMC9532875 DOI: 10.1016/j.xfre.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 07/11/2022] [Accepted: 07/13/2022] [Indexed: 11/18/2022] Open
Abstract
Objective To review the literature to assess best practices for counseling transgender men who desire gender-affirming surgery on fertility preservation options. Design A scoping review of articles published through July 2021. Setting None. Patient(s) Articles published in Cochrane, Web of Science, PubMed, Science Direct, SCOPUS, and Psychinfo. Intervention(s) None. Main Outcome Measure(s) Papers discussing transgender men, fertility preservation (FP), and FP counseling. Result(s) The primary search yielded 1,067 publications. After assessing eligibility and evaluating with a quality assessment tool, 25 articles remained, including 8 reviews, 5 surveys, 4 consensus studies, 3 retrospective studies, 3 committee opinions, and 2 guidelines. Publications highlighted the importance of including the following topics during counseling: (1) FP and family building options; (2) FP outcomes; (3) effects of testosterone therapy on fertility; (4) contraception counseling; (5) attitudes toward family building; (6) consequences of transgender parenting; and (7) barriers to success. Conclusion(s) Currently, there is a lack of standardization for comprehensive counseling about FP for transgender men. Standardized approaches can facilitate conversation between physicians and transgender men and ensure patients are making informed decisions regarding pelvic surgery and future family building plans.
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Affiliation(s)
- Selena U. Park
- Department of Obstetrics, Gynecology and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
- Department of Reproductive Endocrinology and Infertility,Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
- Reprint requests: Selena U. Park, M.D., Department of Obstetrics, Gynecology and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, 125 Paternson Street, New Brunswick, New Jersey 08901.
| | - Devika Sachdev
- Department of Obstetrics, Gynecology and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
- Department of Reproductive Endocrinology and Infertility,Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | | | - Matthew Bridgeman
- Department of Reproductive Endocrinology and Infertility,Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Mark V. Sauer
- Department of Obstetrics, Gynecology and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
- Department of Reproductive Endocrinology and Infertility,Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Gloria Bachmann
- Department of Obstetrics, Gynecology and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
- Department of Obstetrics, Gynecology and Reproductive Sciences, Women’s Health Institute, Rutgers Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, New Jersey
- Department of Reproductive Endocrinology and Infertility,Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Juana Hutchinson-Colas
- Department of Obstetrics, Gynecology and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics, Gynecology and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
- Department of Obstetrics, Gynecology and Reproductive Sciences, Women’s Health Institute, Rutgers Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, New Jersey
- Department of Reproductive Endocrinology and Infertility,Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
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11
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Ker A, Shaw RM, Byrne J, Veale J. Access to fertility preservation for trans and non-binary people in Aotearoa New Zealand. CULTURE, HEALTH & SEXUALITY 2022; 24:1273-1288. [PMID: 34253148 DOI: 10.1080/13691058.2021.1944670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 06/14/2021] [Indexed: 06/13/2023]
Abstract
There is a growing need for healthcare professionals to discuss fertility preservation options with trans and non-binary people before commencing medical transition as part of informed consent-based models of care. In this article, we adapt the Five-A framework of healthcare access to examine fertility preservation information and services. To do so, we present an analysis of data from Counting Ourselves, the first comprehensive national survey in Aotearoa New Zealand of trans and non-binary people's health and the first study exploring their access to cryopreservation information and services. Among 419 participants who had received gender-affirming hormones or surgery, 33.7% received information about options for fertility preservation and 15.8% accessed fertility preservation services. Findings from the study indicate the need for greater understanding of trans and non-binary people's desire for genetically related children, and what type of information and form of delivery would be most helpful to ensure equitable outcomes in relation to decision-making around fertility and future family-building.
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Affiliation(s)
- Alex Ker
- School of Social and Cultural Studies, Victoria University of Wellington, Wellington, New Zealand
| | - Rhonda M Shaw
- School of Social and Cultural Studies, Victoria University of Wellington, Wellington, New Zealand
| | - Jack Byrne
- Trans Health Research Lab and School of Psychology, University of Waikato, Hamilton, New Zealand
| | - Jaimie Veale
- Trans Health Research Lab and School of Psychology, University of Waikato, Hamilton, New Zealand
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12
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Mehra G, Boskey ER, Peters CJ, Njubigbo C, Charlton BM, Ganor O. Assessing Fertility Intentions in Patients Presenting for Gender-Affirming Surgery. LGBT Health 2022; 9:325-332. [PMID: 35749209 DOI: 10.1089/lgbt.2021.0148] [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: For some transgender and gender-diverse (TGD) individuals, gender-affirming surgery may represent the last opportunity to engage in gamete banking (GB) and other forms of fertility preservation (FP). Previous research has assessed fertility intentions among TGD people initiating hormone therapy. The objective of this study was to describe the fertility intentions of patients seeking gender-affirming surgery. Methods: A retrospective chart review was conducted for 233 patients seeking chest or genital surgery between 2017 and 2019. Data abstracted included interest in having children (biological or non-biological) and GB, and barriers to FP. Associations between fertility intentions, sex assigned at birth, and surgical procedure sought were assessed. Results: Of the 233 records reviewed, 162 (70%) documented information about fertility intentions for patients without a history of sterilizing surgery. At initial consultation, 94% were receiving hormone therapy. Among the 60 patients seeking genital surgery, 30% expressed interest in GB and 38% were not interested in biological children. Among the 102 patients seeking chest surgery, 11% expressed interest in GB and 47% were not interested in biological children. Patients assigned male at birth were more likely to have already completed GB (p < 0.001). Among the patients interested in FP, 41% reported barriers to access. Conclusion: Many TGD people in our study expressed no interest in biological parenthood; however, 30% of patients seeking genital surgery expressed interest in GB. This suggests that some who defer FP when starting hormones may wish to pursue it later in life. Ongoing assessment of fertility intentions and reducing barriers to FP are integral to caring for TGD people.
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Affiliation(s)
| | - Elizabeth R Boskey
- Center for Gender Surgery, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston Massachusetts, USA
| | - Carson J Peters
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Chinelo Njubigbo
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Brittany M Charlton
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Division of Adolescent Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Oren Ganor
- Center for Gender Surgery, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston Massachusetts, USA
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13
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Levin NJ, Zhang A, Kattari S, Moravek M, Zebrack B. "Queer Insights": Considerations and Challenges for Assessing Sex, Gender Identity, and Sexual Orientation in Oncofertility Research. ANNALS OF LGBTQ PUBLIC AND POPULATION HEALTH 2022; 3:111-128. [PMID: 38078047 PMCID: PMC10704859 DOI: 10.1891/lgbtq-2021-0015] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
This article addresses issues related to clinical and research approaches to oncofertility for adolescent and young adult (AYA) sexual and gender minority (SGM) cancer patients. Limited attention has been dedicated to understanding the extent to which oncofertility services are appropriately and equitably delivered to AYAs with diverse orientations toward sexual orientation, gender identity, and future family. Unresolved challenges to conducting research with this vulnerable population perpetuate a lack of adequate knowledge about SGM AYA oncofertility needs. Therefore, the purpose of this paper is to inform considerations of sex, gender identity, and sexual orientation for investigations that include SGM AYAs. In order to improve the knowledge base and clinical services for this population, we discuss (1) challenges to sampling this population; (2) categorization and survey logic (e.g., skip patterns) in light of fluid sexual orientation and gender identities; and (3) clinical implications of accurately assessing sex and gender for oncofertility research and practice. We also recommend strategies for producing inclusive and accurate assessments of sexual and gender identity categories in both research and clinical encounters with SGM AYAs. Incorporating "queer insights" into empirical research - that is, positioning queer theory at the center of oncofertility study design - is suggested as a future direction for oncofertility research and practice.
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Affiliation(s)
- Nina Jackson Levin
- University of Michigan, School of Social Work and Department of Anthropology
| | - Anao Zhang
- University of Michigan, School of Social Work
| | - Shanna Kattari
- University of Michigan, School of Social Work and Department of Women’s and Gender Studies
| | - Molly Moravek
- University of Michigan, Department of Obstetrics and Gynecology and Department of Urology, Ann Arbor, MI, USA
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14
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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.
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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
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15
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Rodriguez-Wallberg K, Obedin-Maliver J, Taylor B, Van Mello N, Tilleman K, Nahata L. Reproductive health in transgender and gender diverse individuals: A narrative review to guide clinical care and international guidelines. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2022; 24:7-25. [PMID: 36713139 PMCID: PMC9879176 DOI: 10.1080/26895269.2022.2035883] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Background Hormonal treatments and surgical interventions practiced with the aim to affirm gender identity in transgender and gender diverse patients may impact their future reproductive ability, family building, and family planning options. Whereas it is recommended by international guidelines to discuss the potential risks of infertility and to present fertility preservation (FP) options to transgender individuals and their families prior to initiating any of these treatments, many barriers still remain. Further, transgender and gender diverse individuals often experience barriers to accessing contraception, abortion, pre-conception care, and comprehensive perinatal care. Aims In this review we summarize the current literature on reproductive healthcare issues reported in transgender people including fertility issues, fertility preservation (FP), contraception, pregnancy and lactation and perinatal health. Methods A narrative literature search of major databases (Pubmed, Medline, PsycInfo, Google Scholar, Web of Science) was conducted. Given the paucity and heterogeneity of studies, summative review tactics were not available. The literature was critically reviewed by international experts in the field with focus on the impact of gender-affirming medical interventions on future fertility, current FP options and reproductive health issues in transgender people. Results The current literature supports that transgender and gender diverse individuals may wish to have genetically related children in the future, rendering the issue of FP relevant to this patient group. The cryopreservation of mature gametes is an efficacious option for FP for post-pubertal adolescents and adults. It is recommended to discuss these options at time of planning for gender-affirming hormonal therapy (GAHT) or engaging with other gender-affirming procedures that can limit future fertility. Discontinuation of GAHT may allow individuals to undergo FP later, but data are limited and there is the concern of symptoms and consequences of stopping GAHT. For pre-pubertal and early pubertal children, FP options are limited to the cryopreservation of gonadal tissue. At present the tissue can become functional only after re-transplantation, which might be undesirable by transgender individuals in the future. Preconception counseling, prenatal surveillance, perinatal support, contraceptive, and pregnancy termination related healthcare need to be meaningfully adapted for this patient population, and many knowledge gaps remain. Discussion Specialized FP reproductive healthcare for transgender and gender diverse individuals is in early evolution. Research should be conducted to examine effects of medical interventions on fertility, timing of FP, gamete preservation and outcome of the fertility treatments. Strategies to inform and educate transgender and gender diverse patients can lead to optimization of reproductive care and counseling and decision making of FP for this population.
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Affiliation(s)
- Kenny Rodriguez-Wallberg
- Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pahology, Karolinska Institutet, Stockholm, Sweden
- Laboratory of Translational Fertility Preservation, NKS, Stockholm, Sweden
| | - Juno Obedin-Maliver
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Bernard Taylor
- Department of Obstetrics and Gynecology, Atrium Health, Charlotte, NC, USA
| | - Norah Van Mello
- Department of Obstetrics and Gynecology and Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Kelly Tilleman
- Department for Reproductive Medicine, Ghent University Hospital, Ghent, Belgium
| | - Leena Nahata
- Center for Biobehavioral Health, The Abigail Wexner Research Institute, Columbus, OH, USA
- Division of Pediatric Endocrinology, Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
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16
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Rogers C, Webberley M, Mateescu R, El Rakhawy Y, Daly-Gourdialsing A, Webberley H. A retrospective study of positive and negative determinants of gamete storage in transgender and gender-diverse patients. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2021; 22:167-178. [PMID: 34961859 PMCID: PMC8040686 DOI: 10.1080/26895269.2020.1848693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Background: GenderGP is a novel, online telemedicine service for transgender and gender-diverse individuals. As part of the service, people are offered fertility counseling in regard to gamete storage. Aims: This study aims to formally categorize the reasons that transgender and gender-diverse people do and not store gametes prior to hormonal treatments. We hope to use this data and subsequent research to inform healthcare policy, improve the healthcare experience for transgender and gender-diverse people, and inform legislation for permanent change in UK healthcare. Methods: Data sets (electronic medical records) from June 2015 - April 2020 were derived from the GenderGP patient database. All patients starting treatment with GenderGP and undergoing routine fertility counseling were included in the study. Results: Of 3667 patients aged 10-85, 2722 (74.2%) were aged 18-45. 151 (5.4%) patients stored gametes. 678 (18.5%) patients wanted to store: 268 (39.5%) could not afford gamete storage, 84 (12.4%) had no local services, 307 (45.3%) did not want to delay hormone treatment. 2085 patients did not want to undertake gamete storage, 480 (23.0%) hoped to adopt, 1605 (77.1%) did not want children. All ages showed similar patterns. Discussion: Financial barriers mean many transgender and gender-diverse people cannot access fertility healthcare. Many participants suffered low self-esteem and struggled to envisage an accepting healthcare system, making them less likely to seek advice. Many patients favored adoption over gamete storage. Younger patients (<18) often had very definite views on gamete storage. Many older patients without children would consider gamete storage and adoption, once their transition is complete.
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17
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Chong LSH, Kerklaan J, Clarke S, Kohn M, Baumgart A, Guha C, Tunnicliffe DJ, Hanson CS, Craig JC, Tong A. Experiences and Perspectives of Transgender Youths in Accessing Health Care: A Systematic Review. JAMA Pediatr 2021; 175:1159-1173. [PMID: 34279538 DOI: 10.1001/jamapediatrics.2021.2061] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
IMPORTANCE Transgender and nonbinary youths have a higher incidence of a range of health conditions and may paradoxically face limited access to health care. OBJECTIVE To describe the perspectives and needs of transgender youths in accessing health care. EVIDENCE REVIEW MEDLINE, Embase, PsycInfo, and the Cumulative Index to Nursing and Allied Health Literature were searched from inception to January 2021. Qualitative studies of transgender youths' perspectives on accessing health care were selected. Results from primary studies were extracted. Data were analyzed using thematic synthesis. FINDINGS Ninety-one studies involving 884 participants aged 9 to 24 years across 17 countries were included. We identified 6 themes: experiencing pervasive stigma and discrimination in health care, feeling vulnerable and uncertain in decision-making, traversing risks to overcome systemic barriers to transitioning, internalizing intense fear of consequences, experiencing prejudice undermining help-seeking efforts, and experiencing strengthened gender identity and finding allies. Each theme encapsulated multiple subthemes. CONCLUSIONS AND RELEVANCE This review found that transgender youths contend with feelings of gender incongruence, fear, and vulnerability in accessing health care, which are compounded by legal, economic, and social barriers. This can lead to disengagement from care and resorting to high-risk and unsafe interventions. Improving access to gender-affirming care services with a cultural humility lens and addressing sociolegal stressors may improve outcomes in transgender and nonbinary youths.
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Affiliation(s)
- Lauren S H Chong
- Faculty of Medicine, University of New South Wales, Sydney, Australia.,Sydney School of Public Health, University of Sydney, Sydney, Australia.,Kids Research, The Children's Hospital at Westmead, Westmead, Australia
| | - Jasmijn Kerklaan
- Kids Research, The Children's Hospital at Westmead, Westmead, Australia.,Department of Pediatric Nephrology, Emma Children's Hospital, Amsterdam UMC, Amsterdam, the Netherlands
| | - Simon Clarke
- Centre for Research into Adolescent's Health, Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, Australia.,Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Michael Kohn
- Centre for Research into Adolescent's Health, Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, Australia.,Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Amanda Baumgart
- Sydney School of Public Health, University of Sydney, Sydney, Australia.,Kids Research, The Children's Hospital at Westmead, Westmead, Australia
| | - Chandana Guha
- Sydney School of Public Health, University of Sydney, Sydney, Australia.,Kids Research, The Children's Hospital at Westmead, Westmead, Australia
| | - David J Tunnicliffe
- Sydney School of Public Health, University of Sydney, Sydney, Australia.,Kids Research, The Children's Hospital at Westmead, Westmead, Australia
| | - Camilla S Hanson
- Sydney School of Public Health, University of Sydney, Sydney, Australia.,Kids Research, The Children's Hospital at Westmead, Westmead, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Allison Tong
- Sydney School of Public Health, University of Sydney, Sydney, Australia.,Kids Research, The Children's Hospital at Westmead, Westmead, Australia
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18
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Lampe NM, Nowakowski ACH. New horizons in trans and non-binary health care: Bridging identity affirmation with chronicity management in sexual and reproductive services. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2021; 22:141-153. [PMID: 34725654 PMCID: PMC8040691 DOI: 10.1080/26895269.2020.1829244] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Transgender and non-binary people experience erasure, stigma, and discrimination in sexual and reproductive health care. Previous research shows worse sexual and reproductive health outcomes and higher rates of chronicity for trans and non-binary populations as compared to cisgender populations. Historically such outcomes have been framed as separate issues. AIMS To describe methodological approaches for exploring gaps in the sexual and reproductive health care of transgender and non-binary people, and explore intersections between chronic disease management and gender-affirming care. METHODS We critically reviewed methods for studying sexual and reproductive care and chronic condition management among trans and non-binary populations. We focus on two themes: unmet needs and response strategies. RESULTS We summarize findings and opportunities in existing research about service needs in trans and non-binary care. Key barriers to effective sexual and reproductive care for trans and non-binary people include persistent medical myths about trans people and bodies, siloization of different domains of health and associated services, lack of research on how chronic disease treatments interact with transition related care, and lack of active communication between providers and patients about individual care needs and goals. DISCUSSION We recommend methodologically diverse research with trans and non-binary populations capturing: (1) erasure, stigma, and discrimination in sexual and reproductive health care settings; (2) individual, interpersonal, and structural factors catalyzing chronicity; and (3) the impact of sexual and reproductive health disparities on chronic disease outcomes.
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Affiliation(s)
- Nik M. Lampe
- Department of Sociology/Women’s and Gender Studies Program, University of South Carolina, Columbia, South Carolina, USA
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Alexandra C. H. Nowakowski
- Department of Geriatrics/Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Orlando Regional Campus, Orlando, Florida, USA
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19
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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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20
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Gale J, Magee B, Forsyth-Greig A, Visram H, Jackson A. Oocyte cryopreservation in a transgender man on long-term testosterone therapy: a case report. F S Rep 2021; 2:249-251. [PMID: 34278362 PMCID: PMC8267393 DOI: 10.1016/j.xfre.2021.02.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/25/2021] [Accepted: 02/13/2021] [Indexed: 11/29/2022] Open
Abstract
Objective To report a case of ovarian stimulation for the purposes of oocyte cryopreservation in a transgender man without cessation of long-term testosterone therapy. Design Report of a unique case of fertility preservation through ovarian stimulation and oocyte cryopreservation in a transgender man who had been on testosterone therapy for 18 months before treatment. The patient elected to continue testosterone therapy throughout ovarian stimulation and oocyte retrieval. To our knowledge, there have not been any published reports of patients undergoing oocyte cryopreservation while continuing long-term testosterone therapy. Setting Private fertility clinic with university affiliation. Patients A 20-year-old transgender man undergoing oocyte cryopreservation before gonadectomy. Interventions Fertility preservation through oocyte cryopreservation. Main Outcome Measures This patient had a robust response to ovarian gonadotropin stimulation. Leuprolide acetate was used for final oocyte maturation to minimize ovarian hyperstimulation syndrome risk. Results Cryopreservation of 22 mature oocytes. Conclusions Cryopreservation of mature oocytes is possible for patients on continued long-term testosterone therapy. The impact of long-term testosterone therapy on markers of ovarian reserve, reproductive potential, and long-term reproductive outcomes have yet to be elucidated and further studies are needed in this area.
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Affiliation(s)
- Jenna Gale
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Fertility Centre, Ottawa, Ontario, Canada
| | - Bryden Magee
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Fertility Centre, Ottawa, Ontario, Canada.,Centre for Excellence in Transgender Medicine, West Ottawa Specialty Care, Ottawa, Ontario, Canada
| | - Amanda Forsyth-Greig
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada
| | - Hasina Visram
- Department of Obstetrics and Gynecology, Queens University, Kingston, Ontario, Canada
| | - Aaron Jackson
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Fertility Centre, Ottawa, Ontario, Canada
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21
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Birenbaum-Carmeli D, Inhorn MC, Patrizio P. Transgender men's fertility preservation: experiences, social support, and the quest for genetic parenthood. CULTURE, HEALTH & SEXUALITY 2021; 23:945-960. [PMID: 32484394 DOI: 10.1080/13691058.2020.1743881] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 03/13/2020] [Indexed: 05/25/2023]
Abstract
Transgender people assigned female at birth may undergo fertility preservation by egg or embryo freezing, usually prior to gender affirming treatment. In this binational ethnographic study, four transgender men were included as part of a larger comparative project on fertility preservation. In-depth ethnographic interviews allowed informants to talk freely about their fertility preservation experiences, and the circumstances that had enabled them to pursue this option. Prominent in men's accounts were the importance of genetic parenthood and the role of social support from others in the fertility preservation process. Indeed, in all cases, social support-from parents, siblings, partners, peers, physicians and employers-was critical, effectively enabling young transgender men to embark on their fertility preservation journeys and undergo the physically taxing process. This study illustrates the power of thriving through relationships that were critical in young transgender men's experiences of fertility preservation.
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Affiliation(s)
| | - Marcia C Inhorn
- Department of Anthropology, Yale University, New Haven, CT, USA
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22
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Lai TC, Davies C, Robinson K, Feldman D, Elder CV, Cooper C, Pang KC, McDougall R. Effective fertility counselling for transgender adolescents: a qualitative study of clinician attitudes and practices. BMJ Open 2021; 11:e043237. [PMID: 34011585 PMCID: PMC8137211 DOI: 10.1136/bmjopen-2020-043237] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Fertility counselling for trans and gender diverse (TGD) adolescents has many complexities, but there is currently little guidance for clinicians working in this area. This study aimed to identify effective strategies for-and qualities of-fertility counselling for TGD adolescents based on clinicians' experiences. DESIGN We conducted qualitative semi-structured individual interviews in 2019 which explored clinician experiences and fertility counselling practices, perspectives of the young person's experience and barriers and facilitators to fertility preservation access. Data were analysed using thematic analysis. SETTING This qualitative study examined experiences of clinicians at the Royal Children's Hospital-a tertiary, hospital-based, referral centre and the main provider of paediatric TGD healthcare in Victoria, Australia. PARTICIPANTS We interviewed 12 clinicians from a range of disciplines (paediatrics, psychology, psychiatry and gynaecology), all of whom were involved with fertility counselling for TGD adolescents. RESULTS Based on clinician experiences, we identified five elements that can contribute to an effective approach for fertility counselling for TGD adolescents: a multidisciplinary team approach; shared decision-making between adolescents, their parents and clinicians; specific efforts to facilitate patient engagement; flexible personalised care; and reflective practice. CONCLUSIONS Identification of these different elements can inform and hopefully improve future fertility counselling practices for TGD adolescents, but further studies examining TGD adolescents' experiences of fertility counselling are also required.
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Affiliation(s)
- Timothy Chwan Lai
- Austin Health, Heidelberg, Victoria, Australia
- The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Cristyn Davies
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kerry Robinson
- School of Social Sciences, Western Sydney University, Kingswood, New South Wales, Australia
| | - Debi Feldman
- The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Charlotte Victoria Elder
- Austin Health, Heidelberg, Victoria, Australia
- The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Mercy Hospital for Women, Heidelberg, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Charlie Cooper
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Ken C Pang
- The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Rosalind McDougall
- The University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
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23
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Bartholomaeus C, Riggs DW, Sansfaçon AP. Expanding and improving trans affirming care in Australia: experiences with healthcare professionals among transgender young people and their parents. HEALTH SOCIOLOGY REVIEW : THE JOURNAL OF THE HEALTH SECTION OF THE AUSTRALIAN SOCIOLOGICAL ASSOCIATION 2021; 30:58-71. [PMID: 33622200 DOI: 10.1080/14461242.2020.1845223] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 10/28/2020] [Indexed: 05/28/2023]
Abstract
Access to medical care is significant for many transgender young people and their families, which involves interactions with healthcare professionals. While a trans affirming model is used across Australian paediatric gender clinics, this does not automatically mean that all transgender young people and their parents experience the care they receive as affirming. This article considers the experiences and views of transgender young people (aged 11-17) and their parents in relation to healthcare professionals inside and outside of gender clinics in Australia. Ten qualitative interviews were conducted with parent-child dyads in two Australian states. Key themes relating to healthcare professionals were: differing levels of healthcare professional knowledge and affirmation, quality of service is dependent on individual healthcare professionals, and lack of connected services and referral pathways. The discussion explores specific issues arising from the findings that suggest implications for training for healthcare professionals so as to be better equipped to provide trans affirming clinical care.
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Affiliation(s)
- Clare Bartholomaeus
- College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia
| | - Damien W Riggs
- College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia
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24
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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.
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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
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25
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Cultural competence in fertility care for lesbian, gay, bisexual, transgender, and queer people: a systematic review of patient and provider perspectives. Fertil Steril 2021; 115:1294-1301. [PMID: 33610322 DOI: 10.1016/j.fertnstert.2020.12.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/25/2020] [Accepted: 12/02/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To characterize the patient and provider perspectives on cultural competence in lesbian, gay, bisexual, transgender, and queer (LGBTQ+) fertility care. DESIGN Systematic review. SETTING Not applicable. PATIENT(S) LGBTQ+ patients and their partners treated for fertility-related care; fertility providers who treat LGBTQ+ patients. INTERVENTION(S) We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines of six databases: Medline-OVID, EMBASE, CINAHL, Cochrane Library, ClinicalTrials.Gov, and PsycInfo. Citations of full-text articles were hand-searched using the Scopus database. Eligible studies were assessed using the Risk of Bias Instrument for Cross-Sectional Surveys of Attitudes and Practices, as well as the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research. All screening, extraction, and appraisal were completed in duplicate with two independent reviewers. MAIN OUTCOME MEASURE(S) Patient-reported or provider-reported views on LGBTQ+ cultural competence in fertility care, including barriers and facilitators to inclusive care. RESULT(S) Of the 1,747 original database citations, we included 25 studies that met the inclusion criteria. Of the 21 studies that evaluated patient perspectives, 13 studies targeted same-sex cisgender couples while the remainder targeted transgender and gender-nonconforming participants (n = 6) or any individual who identified as a sexual or gender minority (n = 2). Key barriers for LGBTQ+ participants included gender dysphoria, heteronormativity, stigmatization, and psychological distress. The lack of tailored information for LGBTQ+ populations was repeatedly highlighted as a concern. Promising solutions included tailored information, psychosocial interventions, gender-neutral language, and inclusive intake processes. CONCLUSION(S) LGBTQ+ individuals face unique barriers in fertility care, as described by both patients and providers. This review describes a number of implementable solutions for equitable care, which should be given priority for both research and hospital interventions.
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26
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The politics of Danish IVF: reproducing the nation by making parents through selective reproductive technologies. BIOSOCIETIES 2021. [DOI: 10.1057/s41292-020-00217-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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27
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Benaloun E, Sermondade N, Moreau E, Chabbert-Buffet N, Cristofari S, Johnson N, Lévy R, Dupont C. [Fertility preservation for transwomen]. ACTA ACUST UNITED AC 2021; 49:547-552. [PMID: 33434749 DOI: 10.1016/j.gofs.2021.01.007] [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: 06/16/2020] [Indexed: 11/19/2022]
Abstract
The evolution of medical care for transgender people currently makes it possible to propose fertility preservation. Fertility preservation should be initiated before the start of hormonal treatments and/or surgical procedures. The "reproductive" aspect and the desire for parenthood among transgender people have long been ignored. However, these aspects are important to consider and fertility preservation should be discussed before the start of the physical transition. The aim of this review is to assess the literature on fertility preservation for transgender women ("male to female"). Many uncertainties remain regarding the impact of hormonal treatments on the reproductive functions of transgender women and their reversibility. However, the significant increase in the number of recently published articles is evidence of the improvement in the conditions of access to these procedures for women starting a transition process. Nevertheless, there are still a number of barriers that can prevent or delay this process.
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Affiliation(s)
- E Benaloun
- Service de biologie de la reproduction CECOS, AP-HP, hôpital Tenon, Paris, France
| | - N Sermondade
- Service de biologie de la reproduction-CECOS, AP-HP, hôpital Tenon, Sorbonne université, Saint-Antoine Research centre, Inserm équipe lipodystrophies génétiques et acquises, Paris, France
| | - E Moreau
- Service de biologie de la reproduction CECOS, AP-HP, hôpital Tenon, Paris, France
| | - N Chabbert-Buffet
- Service de gynécologie-obstétrique et médecine de la reproduction, AP-HP, hôpital Tenon, Paris, France
| | - S Cristofari
- Service de chirurugie plastique reconstructrice et esthétique, AP-HP, hôpital Tenon, Sorbonne université, Paris, France
| | - N Johnson
- Service de gynécologie-obstétrique et médecine de la reproduction, AP-HP, hôpital Tenon, Paris, France
| | - R Lévy
- Service de biologie de la reproduction-CECOS, AP-HP, hôpital Tenon, Sorbonne université, Saint-Antoine Research centre, Inserm équipe lipodystrophies génétiques et acquises, Paris, France
| | - C Dupont
- Service de biologie de la reproduction-CECOS, AP-HP, hôpital Tenon, Sorbonne université, Saint-Antoine Research centre, Inserm équipe lipodystrophies génétiques et acquises, Paris, France.
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28
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Ethical issues involving fertility preservation for transgender youth. J Assist Reprod Genet 2020; 37:2453-2462. [PMID: 32780317 DOI: 10.1007/s10815-020-01873-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 06/25/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To investigate ethical issues associated with fertility preservation (FP) in transgender youth based on reports of patients and their parents. METHODS Our qualitative study involved in-person interviews with 54 subjects (35 patients and 19 parents). Interviews were audio recorded, transcribed, and verified. Each subject completed a demographic questionnaire, and each patient's medical chart was reviewed for additional information. We analyzed the data using inductive thematic content analysis. RESULTS Themes that emerged included a range of desires and ambivalence about having genetically related children, variability in understanding the potentially irreversible impact of gender affirming hormones (GAHs) on fertility, use of adoption, and the impact of age on decision-making. Subjects (patients and parents) noted barriers to FP, such as cost and insurance coverage. Several parents expressed concern that their transgender children may have future regret about not attempting FP. Both transgender youth and their parents felt FP was an important precaution. CONCLUSIONS Our study took advantage of the richness of personal narratives to identify ongoing ethical issues associated with fertility preservation in transgender youth. Transgender youth and their parents did not fully understand the process of FP, especially regarding the effects of GAHs, had fears that FP could reactivate gender dysphoria, and noted barriers to FP, such as cost, highlighting economic disparity and lack of justice. These findings highlight ethical issues involving the adequacy of informed consent and economic injustice in access to FP despite expressed interest in the topic.
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29
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McGlynn N, Browne K, Sherriff N, Zeeman L, Mirandola M, Gios L, Davis R, Donisi V, Farinella F, Rosińska M, Niedźwiedzka-Stadnik M, Pierson A, Pinto N, Hugendubel K. Healthcare professionals' assumptions as barriers to LGBTI healthcare. CULTURE, HEALTH & SEXUALITY 2020; 22:954-970. [PMID: 31429675 DOI: 10.1080/13691058.2019.1643499] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 07/10/2019] [Indexed: 06/10/2023]
Abstract
Lesbian, gay, bisexual, trans and intersex (LGBTI) people experience significant healthcare inequalities and barriers to healthcare services. Contextualised within six Member States of the European Union (EU), this paper discusses efforts to identify and explore the nature of barriers to healthcare as part of Health4LGBTI, a 2-year pilot project funded by the EU. Data were generated through focus groups and interviews with LGBTI people and healthcare professionals and analysed using thematic analysis. Findings reveal that barriers to healthcare are underpinned by two related assumptions held by healthcare professionals: first, the assumption that patients are heterosexual, cisgender and non-intersex by default; second, the assumption that LGBTI people do not experience significant problems (and therefore that their experience is mostly irrelevant to healthcare). On the other hand, it is notable that responding healthcare professionals were broadly 'LGBTI-friendly'. Thus, we argue that efforts to improve LGBTI healthcare should not be limited to engaging with healthcare professionals with negative views of LGBTI people. Rather, such efforts should also tackle these assumptions amongst LGBTI-friendly healthcare professionals.
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Affiliation(s)
- Nick McGlynn
- School of Environment and Technology, University of Brighton, Brighton, UK
| | - Kath Browne
- Geography Department, Maynooth University, Maynooth, Ireland
| | - Nigel Sherriff
- School of Health Sciences, University of Brighton, Brighton, UK
| | - Laetitia Zeeman
- School of Health Sciences, University of Brighton, Brighton, UK
| | - Massimo Mirandola
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Lorenzo Gios
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Ruth Davis
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Valeria Donisi
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Francesco Farinella
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Magdalena Rosińska
- Department of Infectious Disease Epidemiology and Surveillance, National Institute of Public Health - National Institute of Hygiene, Warsaw, Poland
| | - Marta Niedźwiedzka-Stadnik
- Department of Infectious Disease Epidemiology and Surveillance, National Institute of Public Health - National Institute of Hygiene, Warsaw, Poland
| | | | - Nuno Pinto
- International Lesbian, Gay, Bisexual, Trans and Intersex Association (ILGA) Portugal, Lisbon, Portugal
| | - Katrin Hugendubel
- International Lesbian, Gay, Bisexual, Trans and Intersex Association (ILGA) Europe, Brussels, Belgium
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30
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Fertility Counseling for Transgender Adolescents: A Review. J Adolesc Health 2020; 66:658-665. [PMID: 32115323 DOI: 10.1016/j.jadohealth.2020.01.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 12/22/2019] [Accepted: 01/02/2020] [Indexed: 12/19/2022]
Abstract
International guidelines in transgender health recommend fertility counseling before the commencement of puberty suppression, estrogen, or testosterone, given the potential for these treatments to impair fertility. However, these recommendations provide little actual guidance to clinicians. Consequently, differences in knowledge and attitudes may lead to clinicians adopting different approaches and goals in the fertility counseling they provide. This review draws attention to the disparity between the rates of desire for genetic parenthood among transgender individuals and the actual rates of fertility preservation (FP) and examines different factors in fertility counseling that affect clinical practice and contribute to this disparity. These factors include how a lack of strong evidence-for the effects of hormone therapy on future fertility and success rates of some FP options-impacts upon counseling, transgender peoples' experiences of fertility counseling and preservation, consideration of a young person's developmental stage and the roles of parents and clinicians in the decision-making process, considerations shaping transgender adolescents' decisions to preserve fertility, and access barriers to FP. In doing so, this review highlights the complexities and issues that clinicians must consider when providing fertility counseling to transgender adolescents and-in part-helps to address the lack of detailed clinical guidelines in this area.
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Tasker F, Gato J. Gender Identity and Future Thinking About Parenthood: A Qualitative Analysis of Focus Group Data With Transgender and Non-binary People in the United Kingdom. Front Psychol 2020; 11:865. [PMID: 32435224 PMCID: PMC7218755 DOI: 10.3389/fpsyg.2020.00865] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 04/07/2020] [Indexed: 01/21/2023] Open
Abstract
The idea that people who are transgender or non-binary are not interested in becoming parents has been refuted by several studies. However, both medical unknowns and cisnormativity surround the process of becoming a parent for transgender or non-binary people, with little known about the psychosocial impact on the family formation dilemmas of transgender and non-binary adults. Employing Life Course Theory as our theoretical framework, three focus group interviews were conducted with eleven transgender or non-binary adults. Qualitative data analysis of focus group interview transcripts was conducted through Thematic Analysis. Four overarching interlinked themes were identified concerning the dilemmas perceived by the nine participants who contemplated future parenthood: (i) Balancing a desire for parenthood and desires for other life goals; (ii) Feeling that who I am doesn't fit into the cisgender system of accessing fostering, adoption or fertility services; (iii) Experiencing the conjoined challenges of gender and fertility embodiment as I see them; (iv) Searching for a non-binary or gender appropriate self and the need for flexible future planning centered on reproductive capacity. Overall, thoughts about gender transition were often interwoven with parenthood plans and in a dialectical fashion the desire and intention to have, or not have, children was implicated in satisfaction with gender transition. The significance of these themes is discussed in relation to how hopes for parenthood could be realized without jeopardizing gender identity and the need for a future focused, flexible, and open-minded approach on the part of fertility and adoption services.
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Affiliation(s)
- Fiona Tasker
- Department of Psychological Sciences, Birkbeck, University of London, London, United Kingdom
| | - Jorge Gato
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
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Zwickl S, Wong A, Bretherton I, Rainier M, Chetcuti D, Zajac JD, Cheung AS. Health Needs of Trans and Gender Diverse Adults in Australia: A Qualitative Analysis of a National Community Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16245088. [PMID: 31847083 PMCID: PMC6950552 DOI: 10.3390/ijerph16245088] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/10/2019] [Accepted: 12/10/2019] [Indexed: 11/24/2022]
Abstract
There is an increasing demand for trans and gender diverse (TGD) health services worldwide. Given the unique and diverse healthcare needs of the TGD community, best practice TGD health services should be community-led. We aimed to understand the healthcare needs of a broad group of TGD Australians, how health professionals could better support TGD people, and gain an understanding of TGD-related research priorities. An anonymous online survey received 928 eligible responses from TGD Australian adults. This paper focuses on three questions out of that survey that allowed for free-text responses. The data were qualitatively coded, and overarching themes were identified for each question. Better training for healthcare professionals and more accessible transgender healthcare were the most commonly reported healthcare needs of participants. Findings highlight a pressing need for better training for healthcare professionals in transgender healthcare. In order to meet the demand for TGD health services, more gender services are needed, and in time, mainstreaming health services in primary care will likely improve accessibility. Evaluation of training strategies and further research into optimal models of TGD care are needed; however, until further data is available, views of the TGD community should guide research priorities and the TGD health service delivery.
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Affiliation(s)
- Sav Zwickl
- Trans Medical Research Group, Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Victoria 3084, Australia; (S.Z.); (A.W.); (I.B.); (M.R.); (D.C.); (J.D.Z.)
| | - Alex Wong
- Trans Medical Research Group, Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Victoria 3084, Australia; (S.Z.); (A.W.); (I.B.); (M.R.); (D.C.); (J.D.Z.)
| | - Ingrid Bretherton
- Trans Medical Research Group, Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Victoria 3084, Australia; (S.Z.); (A.W.); (I.B.); (M.R.); (D.C.); (J.D.Z.)
- Department of Endocrinology, Austin Health, Heidelberg, Victoria 3084, Australia
| | - Max Rainier
- Trans Medical Research Group, Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Victoria 3084, Australia; (S.Z.); (A.W.); (I.B.); (M.R.); (D.C.); (J.D.Z.)
| | - Daria Chetcuti
- Trans Medical Research Group, Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Victoria 3084, Australia; (S.Z.); (A.W.); (I.B.); (M.R.); (D.C.); (J.D.Z.)
| | - Jeffrey D. Zajac
- Trans Medical Research Group, Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Victoria 3084, Australia; (S.Z.); (A.W.); (I.B.); (M.R.); (D.C.); (J.D.Z.)
- Department of Endocrinology, Austin Health, Heidelberg, Victoria 3084, Australia
| | - Ada S. Cheung
- Trans Medical Research Group, Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Victoria 3084, Australia; (S.Z.); (A.W.); (I.B.); (M.R.); (D.C.); (J.D.Z.)
- Department of Endocrinology, Austin Health, Heidelberg, Victoria 3084, Australia
- Correspondence:
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33
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Baram S, Myers SA, Yee S, Librach CL. Fertility preservation for transgender adolescents and young adults: a systematic review. Hum Reprod Update 2019; 25:694-716. [DOI: 10.1093/humupd/dmz026] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 06/21/2019] [Accepted: 07/14/2019] [Indexed: 12/17/2022] Open
Abstract
Abstract
BACKGROUND
Many transgender individuals choose to undergo gender-affirming hormone treatment (GAHT) and/or sex reassignment surgery (SRS) to alleviate the distress that is associated with gender dysphoria. Although these treatment options often succeed in alleviating such symptoms, they can also negatively impact future reproductive potential.
OBJECTIVE AND RATIONALE
The purpose of this systematic review was to synthesize the available psychosocial and medical literature on fertility preservation (FP) for transgender adolescents and young adults (TAYAs), to identify gaps in the current research and provide suggestions for future research directions.
SEARCH METHODS
A systematic review of English peer-reviewed papers published from 2001 onwards, using the preferred reporting items for systematic reviews and meta-analyses protocols (PRISMA-P) guidelines, was conducted. Four journal databases (Ovid MEDLINE, PubMed Medline, Ovid Embase and Ovid PsychINFO) were used to identify all relevant studies exploring psychosocial or medical aspects of FP in TAYAs. The search strategy used a combination of subject headings and generic terms related to the study topic and population. Bibliographies of the selected articles were also hand searched and cross-checked to ensure comprehensive coverage. All selected papers were independently reviewed by the co-authors. Characteristics of the studies, objectives and key findings were extracted, and a systematic review was conducted.
OUTCOMES
Included in the study were 19 psychosocial-based research papers and 21 medical-based research papers that explore fertility-related aspects specific for this population. Key psychosocial themes included the desire to have children for TAYAs; FP discussions, counselling and referrals provided by healthcare providers (HCPs); FP utilization; the attitudes, knowledge and beliefs of TAYAs, HCPs and the parents/guardians of TAYAs; and barriers to accessing FP. Key medical themes included fertility-related effects of GAHT, FP options and outcomes. From a synthesis of the literature, we conclude that there are many barriers preventing TAYAs from pursuing FP, including a lack of awareness of FP options, high costs, invasiveness of the available procedures and the potential psychological impact of the FP process. The available medical data on the reproductive effects of GAHT are diverse, and while detrimental effects are anticipated, the extent to which these effects are reversible is unknown.
WIDER IMPLICATIONS
FP counselling should begin as early as possible as a standard of care before GAHT to allow time for informed decisions. The current lack of high-quality medical data specific to FP counselling practice for this population means there is a reliance on expert opinion and extrapolation from studies in the cisgender population. Future research should include large-scale cohort studies (preferably multi-centered), longitudinal studies of TAYAs across the FP process, qualitative studies of the parents/guardians of TAYAs and studies evaluating the effectiveness of different strategies to improve the attitudes, knowledge and beliefs of HCPs.
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Affiliation(s)
- Shira Baram
- Create Fertility Centre, 790 Bay Street, Suite 1100, Toronto, Ontario M5G 1N8, Canada
- Department of Obstetrics and Gynecology, University of Toronto, 27 King’s College Circle, Toronto, Ontario M5S, Canada
| | - Samantha A Myers
- Create Fertility Centre, 790 Bay Street, Suite 1100, Toronto, Ontario M5G 1N8, Canada
- McMaster University, 1280 Main St W, Hamilton, Ontario L8S 4L8, Canada
| | - Samantha Yee
- Create Fertility Centre, 790 Bay Street, Suite 1100, Toronto, Ontario M5G 1N8, Canada
| | - Clifford L Librach
- Create Fertility Centre, 790 Bay Street, Suite 1100, Toronto, Ontario M5G 1N8, Canada
- Department of Obstetrics and Gynecology, University of Toronto, 27 King’s College Circle, Toronto, Ontario M5S, Canada
- Department of Physiology, University of Toronto, 27 King’s College Circle, Toronto, Ontario M5S, Canada
- Institute of Medical Science, University of Toronto, 27 King’s College Circle, Toronto, Ontario M5S, Canada
- Department of Obstetrics and Reproductive Endocrinology, Sunnybrook Health Sciences Centre; 2075 Bayview Ave, Toronto, Ontario M4N 3M5, Canada
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