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Conard R, Folsom L. Family planning preferences in transgender youth in an urban multi-disciplinary gender clinic. J Clin Transl Endocrinol 2024; 36:100353. [PMID: 38828403 PMCID: PMC11143893 DOI: 10.1016/j.jcte.2024.100353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 05/12/2024] [Accepted: 05/16/2024] [Indexed: 06/05/2024] Open
Abstract
Background Known barriers to family planning in the transgender population include low utilization of cryopreservation and decisional regret. There is growing data on the risk of infertility with GAHT, and on to what degree transgender adolescents feel informed about fertility and family planning options. Objective Assess preferences regarding options for family planning and fertility preservation in transgender adolescents treated with GAHT in a pediatric endocrinology gender clinic. The goal is to enhance patient education about potential effects of GAHT on fertility and options for family planning. Methods Forty one adolescents aged 10 years and older treated with GAHT in an urban outpatient pediatric endocrinology clinic were surveyed over a 6-month period from January to June 2022. Survey questions were multiple choice, Likert scale, and open-ended. Participants were at least 10 years of age, actively followed in the clinic, and receiving GAHT at time of enrollment. Results Forty one participants completed the survey. Four (10 %) expressed interest in discussing family planning with their provider. Eighteen (45 %) were open to discussion in the future; 16 (39 %) were not interested at all. 12 (30 %) participants were planning for future parenthood, and 16 (40 %) participants were undecided. Of those interested in parenthood 7 (53.8 %) planned to adopt or foster. Barriers to family planning expressed included financial concerns, potential need to pause GAHT, and social stigma of transgender parenthood. Twenty (50 %) participants recalled prior family planning discussion with their endocrinologist. Conclusion Family planning discussions may not be optimally impactful given that 50 % of participants did not recall the conversations. Family planning is a lower priority in this population as most desired to postpone discussion with their provider despite choosing treatment that could influence fertility. It is essential to identify methods to engage transgender youth in discussions related to family planning during GAHT.
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Affiliation(s)
- Ryan Conard
- University of Louisville, School of Medicine Department of Pediatrics, affiliated with Norton Children’s Medical Group, 571 S. Floyd Street, Ste. 432, Louisville, KY 40202, USA
| | - Lisal Folsom
- University of Louisville School of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, 571 S. Floyd Street, Ste. 128, Louisville, KY 40202, USA
- Norton Children’s Medical Group – Pediatric Endocrinology, 411 E. Chestnut St.. 7 Floor, Louisville, KY 40202, USA
- Norton Healthcare – Endocrinology, 210 E. Gray St, Ste 605, Louisville, KY 40202, USA
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2
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Nadgauda AS, Butts S. Barriers to fertility preservation access in transgender and gender diverse adolescents: a narrative review. Ther Adv Reprod Health 2024; 18:26334941231222120. [PMID: 38292918 PMCID: PMC10826369 DOI: 10.1177/26334941231222120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 11/24/2023] [Indexed: 02/01/2024] Open
Abstract
Fertility preservation (FP) involves the cryopreservation of gametes, embryos, and/or gonadal tissue oocytes, for future use in family building. FP as part of a comprehensive approach to care of transgender and gender diverse (TGD) individuals is an understudied topic. Current evidence indicates that gender affirming therapies may increase the risk for infertility. As a result, TGD individuals, including adolescents, should receive counseling regarding FP prior to beginning gender affirming treatment. Many barriers exist to TGD adolescents receiving FP counseling and undergoing FP if desired. The objective of this narrative review is to summarize the literature regarding the desire for FP in TGD adolescents, the barriers to TGD adolescents in accessing of FP, and to discuss potential interventions for alleviation of such barriers. A literature search using the following Medical Subject Headings search terms: 'transgender persons' and 'fertility preservation' and 'adolescents' was conducted via searching PubMed. Additional articles were located via reference review. Included articles consist of qualitative and quantitative research and society guidelines. Articles from inception to 1st July 2023 were included. The results of the literature search have been summarized into the format of a narrative review. Key barriers to FP for TGD adolescents include inconsistencies in form and timing of counseling, potential worsening of gender dysphoria with FP treatment, high cost of treatment, limited research on FP outcomes, and legal barriers. Intersectionality between gender identity and other forms of minority status can compound these barriers to FP and healthcare in general. Barriers to TGD adolescents accessing FP are significant. Increased research is needed upon methods to mitigate these barriers. Solutions include increasing uniformity and timing of FP counseling by varying health care providers, advocacy efforts to mitigate legal and financial barriers, increased research efforts in FP outcomes, and increased cultural competency in clinics offering FP care to TGD adolescents.
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Affiliation(s)
- Ashni S. Nadgauda
- Department of Obstetrics and Gynecology, Reading Hospital – Tower Health, 420 South 5th Avenue, Reading, PA 19611, USA
| | - Samantha Butts
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Penn State – Main Campus, Hershey, PA, USA
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3
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Barda S, Amir H, Mizrachi Y, Dviri M, Yaish I, Greenman Y, Sofer Y, Azem F, Hauser R, Lantsberg D. Sperm parameters in Israeli transgender women before and after cryopreservation. Andrology 2023; 11:1050-1056. [PMID: 36542410 DOI: 10.1111/andr.13369] [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: 09/09/2022] [Revised: 11/28/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The application of fertility preservation, initially intended for oncological patients prior to gonadotoxic treatment, has extended in recent years to transgender and gender-non-conforming individuals undergoing therapy for gender compatibility. OBJECTIVES To examine semen quality and survival in transgender women pursuing semen cryopreservation in the presence or absence of gender-affirming hormonal medication. MATERIALS AND METHODS In this retrospective cohort study, we reviewed data of 74 consecutive transgender women presenting for semen cryopreservation at a single center between 2000 and 2019. Semen parameters before and after cryopreservation were compared to a control group composed of 100 consecutive sperm bank donor candidates. A subgroup analysis of subjects who had used gender-affirming hormonal treatment was also performed. RESULTS Compared to the control group, transgender women had lower total sperm count (144.0 vs. 54.5 million, respectively, p < 0.001), lower sperm motility percentage (65.0% vs. 51.0%, respectively, p < 0.001), and lower total motile sperm count (94.0 vs. 27.0 million, respectively, p < 0.001). Values were further decreased in transgender women who had received hormonal treatment before sperm cryopreservation. Post-thawing motility rate remained lower in the transgender group compared to the control group (20.0% vs. 45.0%, respectively, p < 0.001), and the total motile count remained lower as well (2.7 vs. 9.0 million, respectively, p < 0.001). Following sperm cryopreservation, the post-thaw decreases in total motile sperm count were higher in the transgender group compared with the control group (91.5% vs. 90.0%). Further subdivision in the transgender group showed that the decrease in total motile sperm count was lower for transgender women who did not use gender-affirming hormonal treatment compared to those who did (-89.7% vs. -92.6%, respectively, p < 0.01). DISCUSSION AND CONCLUSION Sperm parameters in transgender women are poor compared to candidates for sperm donation representing the general population. Specimens collected after discontinuation of gender-affirming hormone treatments were further impaired. Moreover, post-thawing sperm total motile count, motility, and overall sperm survival were reduced in transgender women.
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Affiliation(s)
- Shimi Barda
- The Institute for the Study of Fertility, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Israel Academic College, Ramat Gan, Israel
| | - Hadar Amir
- Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yossi Mizrachi
- The Royal Women's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Michal Dviri
- Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Iris Yaish
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yona Greenman
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Sofer
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Foad Azem
- Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Hauser
- The Institute for the Study of Fertility, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Lantsberg
- The Institute for the Study of Fertility, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- The Royal Women's Hospital, University of Melbourne, Melbourne, Victoria, Australia
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4
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Bayar E, Williams NJ, Alghrani A, Murugesu S, Saso S, Bracewell-Milnes T, Thum MY, Nicopoullos J, Sangster P, Yasmin E, Smith JR, Wilkinson S, Pacey A, Jones BP. Fertility preservation and realignment in transgender women. HUM FERTIL 2023; 26:463-482. [PMID: 36799335 DOI: 10.1080/14647273.2022.2163195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 09/01/2022] [Indexed: 02/18/2023]
Abstract
Medical care for transgender people is multi-faceted and attention to individual reproductive aspirations and planning are an essential, yet often overlooked aspect of care. Given the impact of hormonal therapy and other gender affirmation procedures on reproductive function, extensive counselling and consideration of fertility preservation is recommended prior to their commencement. This review article explores the reproductive aspirations of transgender women and considers the current disparity between stated desires regarding utilisation of fertility preservation services. Current fertility preservation options and prospective treatments currently showing promise in the research arena are explored.
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Affiliation(s)
- Erna Bayar
- Department of Gynaecology, Hammersmith Hospital, Imperial College NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Nicola J Williams
- Department of Politics, Philosophy and Religion, Lancaster University, Lancaster, UK
| | - Amel Alghrani
- School of Law and Social Justice, University of Liverpool, Liverpool, UK
| | - Sughashini Murugesu
- Department of Gynaecology, Hammersmith Hospital, Imperial College NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Srdjan Saso
- Department of Gynaecology, Hammersmith Hospital, Imperial College NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - Meen-Yau Thum
- Lister Fertility Clinic, The Lister Hospital, Chelsea Bridge Road, London, UK
| | - James Nicopoullos
- Lister Fertility Clinic, The Lister Hospital, Chelsea Bridge Road, London, UK
| | - Philippa Sangster
- Reproductive Medicine Unit, University College London Hospital, London, UK
| | - Ephia Yasmin
- Reproductive Medicine Unit, University College London Hospital, London, UK
| | - J Richard Smith
- Department of Gynaecology, Hammersmith Hospital, Imperial College NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Stephen Wilkinson
- Department of Politics, Philosophy and Religion, Lancaster University, Lancaster, UK
| | - Allan Pacey
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
| | - Benjamin P Jones
- Department of Gynaecology, Hammersmith Hospital, Imperial College NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
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5
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Kyweluk MA, Kirkley J, Grimstad F, Amato P, Downing J. Desire for genetically related children among transgender and gender-diverse patients seeking gender-affirming hormones. F S Rep 2023; 4:224-230. [PMID: 37398606 PMCID: PMC10310968 DOI: 10.1016/j.xfre.2023.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 04/10/2023] [Accepted: 04/10/2023] [Indexed: 07/04/2023] Open
Abstract
Objective To assess predictors of desire for genetically related children among a national cohort of reproductive-age transgender and gender-diverse patients aged 18 to 44 years initiating gender-affirming hormone therapy for the first time. Design Cross-sectional study. Setting National telehealth clinic. Patients A cohort of patients from 33 US states initiating gender-affirming hormone therapy. A total of 10,270 unique transgender and gender-diverse patients-aged 18 to 44 years (median age 24 years), with no prior use of gender-affirming hormone therapy-completed clinical intake forms between September 1, 2020, and January 1, 2022. Interventions Patient sex assigned at birth, insurance status, age, and geographic location. Main Outcome Measures Self-reported desire for children using own genetic material. Results Transgender and gender-diverse patients seeking gender-affirming medical treatments who are open to having genetically related children are an important population to identify and appropriately counsel. Over one quarter of the study population reported being interested in or unsure about having genetically related children, with 17.8% reporting yes and 8.4% unsure. Male-sex-assigned-at-birth patients had 1.37 (95% confidence interval: 1.25, 1.41) times higher odds of being open to having genetically related children compared with female-sex-assigned-at-birth patients. Those with private insurance had 1.13 (95% confidence interval: 1.02, 1.37) times higher odds of being open to having genetically related children compared with those without insurance. Conclusions These findings represent the largest source of self-reported data on the desire for genetically related children among reproductive-age adult transgender and gender-diverse patients seeking gender-affirming hormones. Guidelines recommend that providers offer fertility-related counseling. These results indicate that transgender and gender-diverse patients, particularly male-sex-assigned-at-birth individuals and patients with private insurance, could benefit from counseling regarding the impacts of gender-affirming hormone therapy and gender-affirming surgeries on fertility.
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Affiliation(s)
- Moira A. Kyweluk
- Plume Health, Denver, Colorado
- Third Space, LLC, Philadelphia, Pennsylvania
| | | | - Frances Grimstad
- Division of Gynecology, Department of Surgery, Boston Children’s Hospital, Cambridge, Massachusetts
- Department of Obstetrics, Gynecology, Reproductive Biology, Harvard Medical School, Cambridge, Massachusetts
| | - Paula Amato
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
| | - Jae Downing
- School of Public Health, Oregon Health & Science University, Portland, Oregon
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6
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Conflitti AC, Spaziani M, Pallotti F, Tarsitano MG, Di Nisio A, Paoli D, Lombardo F. Update on bioethical, medical and fertility issues in gender incongruence during transition age. J Endocrinol Invest 2023:10.1007/s40618-023-02077-5. [PMID: 37071372 PMCID: PMC10371879 DOI: 10.1007/s40618-023-02077-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/22/2023] [Indexed: 04/19/2023]
Abstract
PURPOSE Many issues still remain unresolved in the management of pubertal patients with gender incongruence (GI). The aim of this review is to discuss the main aspects of the treatment of these patients to provide a practical approach for clinicians. METHODS A comprehensive literature search within PubMed was performed to provide updates of available evidence regarding the impact on bioethical, medical and fertility issues in gender incongruence during transition age. RESULTS Gender Affirming Hormone Treatment (GAHT) and Gender Affirming Surgery (GAS) can induce unsatisfaction with change, future regrets, and the risk of infertility. This raises ethical issues especially in the management of pubertal patients that remain unresolved. Therapy with GnRH analogues (GnRHa) is intended to delay puberty, so as to give the adolescent a longer period of time to decide whether to continue with the treatments. At the level of physical changes, this therapy may have an effect on bone mineralization and body composition; however, long-term longitudinal data are not yet available. An important feature related to the use of GnRHa is the risk of fertility. Gamete cryopreservation is the most established method of fertility preservation (FP) and should be counselled to transgender adolescents. However, these patients are not always interested in having biological children. CONCLUSION Based on the current evidence, there is a need to conduct further research to clarify certain issues and to standardize clinical practice and improve counselling in transgender adolescent decision making and avoid regrets in the future.
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Affiliation(s)
- A C Conflitti
- Laboratory of Seminology-Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - M Spaziani
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Viale del Policlinico 155, 00161, Rome, Italy
| | - F Pallotti
- Laboratory of Seminology-Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - M G Tarsitano
- Department of Medical and Surgical Science, University Magna Graecia, Catanzaro, Italy
| | - A Di Nisio
- Department of Medicine, Operative Unit of Andrology and Medicine of Human Reproduction, University of Padova, Padua, Italy
| | - D Paoli
- Laboratory of Seminology-Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
| | - F Lombardo
- Laboratory of Seminology-Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
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7
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Hartman N, James C, Barrera EP, Grimstad FW, El-Arabi AM. Effects on Fertility and the Preservation of Fertility in the Transgender Patient. CURRENT SEXUAL HEALTH REPORTS 2023. [DOI: 10.1007/s11930-023-00355-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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8
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Stolk THR, Asseler JD, Huirne JAF, van den Boogaard E, van Mello NM. Desire for children and fertility preservation in transgender and gender-diverse people: A systematic review. Best Pract Res Clin Obstet Gynaecol 2023; 87:102312. [PMID: 36806443 DOI: 10.1016/j.bpobgyn.2023.102312] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/30/2022] [Accepted: 01/13/2023] [Indexed: 01/22/2023]
Abstract
The decision to pursue one's desire for children is a basic human right. For transgender and gender-diverse (TGD) people, gender-affirming care may alter the possibilities to fulfill one's desire for children due to the impact of this treatment on their reproductive organs. We systematically included 76 studies of varying quality describing the desire for children and parenthood; fertility counseling and utilization; and fertility preservation options and outcomes in TGD people. The majority of TGD people expressed a desire for children. Fertility preservation utilization rates were low as there are many barriers to pursue fertility preservation. The most utilized fertility preservation strategies include oocyte vitrification and sperm banking through masturbation. Oocyte vitrification showed successful outcomes, even after testosterone cessation. Sperm analyses when banking sperm showed a lower quality compared to cis male samples even prior to gender-affirming hormone treatment and an uncertain recovery of spermatogenesis after discontinuing treatment.
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Affiliation(s)
- T H R Stolk
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Center of Expertise on Gender Dysphoria, De Boelelaan 1117, Amsterdam University Medical Centers, the Netherlands; Amsterdam UMC, Department of Obstetrics & Gynaecology, Amsterdam, the Netherlands; Amsterdam Reproduction and Development, Amsterdam, the Netherlands.
| | - J D Asseler
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Center of Expertise on Gender Dysphoria, De Boelelaan 1117, Amsterdam University Medical Centers, the Netherlands; Amsterdam UMC, Department of Obstetrics & Gynaecology, Amsterdam, the Netherlands; Amsterdam Reproduction and Development, Amsterdam, the Netherlands.
| | - J A F Huirne
- Amsterdam UMC, Department of Obstetrics & Gynaecology, Amsterdam, the Netherlands; Amsterdam Reproduction and Development, Amsterdam, the Netherlands.
| | - E van den Boogaard
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Center of Expertise on Gender Dysphoria, De Boelelaan 1117, Amsterdam University Medical Centers, the Netherlands; Amsterdam UMC, Department of Obstetrics & Gynaecology, Amsterdam, the Netherlands; Amsterdam Reproduction and Development, Amsterdam, the Netherlands.
| | - N M van Mello
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Center of Expertise on Gender Dysphoria, De Boelelaan 1117, Amsterdam University Medical Centers, the Netherlands; Amsterdam UMC, Department of Obstetrics & Gynaecology, Amsterdam, the Netherlands; Amsterdam Reproduction and Development, Amsterdam, the Netherlands.
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9
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Adeleye AJ, Stark BA, Jalalian L, Mok-Lin E, Smith JF. Evidence of Spermatogenesis in the Presence of Hypothalamic Suppression and Low Testosterone in an Adolescent Transgender Female: A Case Report. Transgend Health 2023; 8:104-107. [PMID: 36895316 PMCID: PMC9991424 DOI: 10.1089/trgh.2021.0034] [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] [Indexed: 11/12/2022] Open
Abstract
Objective To report a novel case of semen cryopreservation after testicular sperm extraction in an adolescent transgender female without cessation of gonadotropin-releasing hormone (GnRH) agonist therapy and feminizing hormone therapy. Methods This is a case report of a 16-year-old transgender female using leuprolide acetate for 4 years and estradiol for 3 years requesting semen cryopreservation at the time of gender-affirming orchiectomy. She desired to proceed without cessation of gender affirming hormone therapy. The patient's consent was obtained for written publication. Results The patient underwent testicular sperm extraction followed by orchiectomy. The sample was processed and cryopreserved in a 1:1 Test Yolk Buffer. Multiple early and late spermatids were identified as well as spermatagonium in the TESE specimen. Conclusions Advanced spermatogenesis may occur in the presence of a GnRH agonist. Cessation of GnRH agonist therapy may not be essential for semen cryopreservation in adolescent transgender females.
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Affiliation(s)
- Amanda J. Adeleye
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
| | - Brett A. Stark
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
| | - Liza Jalalian
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
| | - Evelyn Mok-Lin
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
| | - James F. Smith
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
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10
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Hollingshead N, Hodax JK, Boos MD. Management of acne in transgender and gender diverse youth Part 2: Unique considerations and strategies in medical treatment. Pediatr Dermatol 2022; 39:870-875. [PMID: 35973559 DOI: 10.1111/pde.15114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 07/31/2022] [Indexed: 11/28/2022]
Abstract
Acne vulgaris is among the most common skin disorders afflicting adolescents worldwide, and though well-established guidelines of care exist for acne management, these guidelines do not uniformly consider or address the unique psychosocial and medical needs of transgender and gender diverse (TGD) youth. Part 2 of this two-part review provides guidance on a stepwise approach to the medical treatment of acne in TGD youth, with an emphasis on safety, efficacy, and the delivery of medical care in a culturally humble, thoughtful, and gender-affirming manner.
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Affiliation(s)
| | - Juanita K Hodax
- Division of Endocrinology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington, USA
| | - Markus D Boos
- Division of Dermatology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington, USA
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11
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Dilday EA, Bukulmez O, Saner K, Lopez X, Jarin J. Sperm Cryopreservation Outcomes in Transgender Adolescents Compared with Adolescents Receiving Gonadotoxic Therapy. Transgend Health 2022; 7:528-532. [PMID: 36644123 PMCID: PMC9829158 DOI: 10.1089/trgh.2021.0037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Purpose The target population for fertility preservation recently has been expanded from adolescents with cancer undergoing gonadotoxic chemotherapy to include transgender youth before initiating gender-affirming hormone therapy. Patients and providers may have knowledge deficits regarding options for fertility preservation, accessibility, and feasibility of its techniques, and impact of treatment on future fertility. This study describes outcomes of sperm cryopreservation in transgender male-to-female (affirmed female) youth and compares semen parameters with adolescents diagnosed with cancer. Methods Medical records of transgender-affirmed female adolescents and adolescent males diagnosed with cancer who underwent sperm cryopreservation at the Fertility and Advanced Reproductive Medicine clinic of the University of Texas (UT) Southwestern Medical Center between March 2015 and March 2020 were reviewed. Demographic data were recorded and values for sperm parameters (volume, count, total count, motility (%), total motile) were collected. When available, hormone levels (luteinizing hormone, follicle-stimulating hormone, testosterone, and estradiol) and Tanner stages were also assessed. The two populations were compared using chi-square analysis and two-sample student's t-test. Data are presented as mean±standard deviation. Results While semen quality parameters trended lower in transgender youth compared with adolescents with cancer, there was no statistically significant difference between groups. While four out of 18 patients in the transgender group had azoospermia, mean semen quality parameters fell within normal adult reference ranges for both groups. Conclusion Sperm cryopreservation for transgender youth and adolescents with cancer is feasible, inexpensive, and does not result in significant treatment delays. This information can improve counseling and access to these procedures, particularly in the transgender population.
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Affiliation(s)
- Elizabeth A. Dilday
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Orhan Bukulmez
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Karla Saner
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ximena Lopez
- Department of Pediatrics, Children's Health, Dallas, Texas, USA
| | - Jason Jarin
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Pediatrics, Children's Health, Dallas, Texas, USA
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12
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Fertility Preservation and Reproductive Potential in Transgender and Gender Fluid Population. Biomedicines 2022; 10:biomedicines10092279. [PMID: 36140377 PMCID: PMC9496568 DOI: 10.3390/biomedicines10092279] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/09/2022] [Accepted: 09/11/2022] [Indexed: 11/16/2022] Open
Abstract
The gender diverse and transgender community is a minor patient group that is encountered with increasing frequency in the clinical setting, attributed to the improved awareness and access to medical facilities. Partial impairment to permanent elimination of fertility potential and outcomes depending on the treatment modality usually is a result of gender-affirming therapy, which includes both hormone therapy and surgical intervention. Although seldom conducted in the clinical field, transgender patients should be counseled on their fertility preservation options prior to medical and surgical gender transition. There is relatively limited data and clinical information regarding fertility preservation for transgender individuals. Current treatment regimens are based on protocols from fertility preservation after oncological treatments. Major barriers for the transgender population exist due to the lack of information provided and clinical narrative that is not familiar to the physician or health care provider, although there are various options for fertility preservation. A deeper understanding of this clinical agenda and the mandatory processes will ultimately result in a much more comprehensive and specific care for transgender individuals who are in great need for fertility counseling or treatment options that concern fertility preservation. In this review, current clinical approaches will be summarized and fertility preservation options along with ongoing and future clinical trials in fertility preservation for transgender individuals will be thoroughly reviewed.
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Cooper HC, Long J, Aye T. Fertility preservation in transgender and non-binary adolescents and young adults. PLoS One 2022; 17:e0265043. [PMID: 35275955 PMCID: PMC8916634 DOI: 10.1371/journal.pone.0265043] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 02/22/2022] [Indexed: 11/18/2022] Open
Abstract
Although 37.5–51% of transgender adults state they would’ve considered freezing gametes before gender-affirming therapy if offered and 24–25.8% of transgender adolescents express interest in having biological children, less than 5% of transgender adolescents have opted for fertility preservation. We sought to assess fertility preservation utilization in our multidisciplinary adolescent gender clinic. We also aimed to identify fertility preservation utilization and interest among non-binary adolescents and young adults. A retrospective review was conducted of patients seen in the Stanford Pediatric & Adolescent Gender Clinic from October 2015 through March 2019 who were >10 years of age at initial visit. All individuals with documented discussion of fertility preservation were offered referral for formal fertility preservation consultation but only 24% of patients accepted. Only 6.8% of individuals subsequently underwent fertility preservation (n = 9). Transfeminine adolescents are more likely to pursue fertility preservation than transmasculine adolescents (p = 0.01). The rate of fertility preservation in non-binary adolescents did not significantly differ from those in transfeminine adolescents (p = 1.00) or transmasculine adolescents (p = 0.31). Although only one non-binary individual underwent fertility preservation, several more expressed interest with 36% accepting referral (n = 4) and 27% being seen in consultation (n = 3). Despite offering fertility preservation with designated members of a gender clinic team, utilization remains low in transgender adolescents. Additionally, non-binary adolescents and their families are interested in fertility preservation and referrals should be offered to these individuals. Further studies and advocacy are required to continue to address fertility needs of transgender adolescents.
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Affiliation(s)
- Holly C. Cooper
- Department of Pediatric Endocrinology, Mary Bridge Children’s Hospital, Tacoma, Washington, United States of America
- * E-mail:
| | - Jin Long
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, United States of America
| | - Tandy Aye
- Department of Pediatric Endocrinology, Mary Bridge Children’s Hospital, Tacoma, Washington, United States of America
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Verma K, Sagun BK, Rasouli MA, Duke CM. Social media engagement with transgender fertility content. F S Rep 2021; 3:100-105. [PMID: 35937448 PMCID: PMC9349237 DOI: 10.1016/j.xfre.2021.12.005] [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: 08/02/2021] [Revised: 12/13/2021] [Accepted: 12/16/2021] [Indexed: 11/30/2022] Open
Abstract
Objective Design Setting Patient(s) Intervention(s) Main Outcome Measure(s) Result(s) Conclusion(s)
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Affiliation(s)
- Kajal Verma
- Department of Obstetrics and Gynecology, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada
- Correspondence: Kajal Verma, M.D., Department of Obstetrics and Gynecology, Kirk Kerkorian School of Medicine at UNLV, 1701 W Charleston Blvd., Ste. 29, Las Vegas, Nevada 89102.
| | | | - Melody A. Rasouli
- Department of Obstetrics and Gynecology, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada
| | - Cindy M. Duke
- Department of Obstetrics and Gynecology, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada
- Nevada Fertility Institute, Las Vegas, Nevada
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Eustache F, Drouineaud V, Mendes N, Delépine B, Dupont C, Mirallié S, Papaxanthos A, Metzler-Guillemain C, Rives-Feraille A, Magnan F, Grèze C, Hennebicq S, Koscinski I, Drapier H, Frapsauce C, Mayeur A, Carlotti MA, Mons J, Schmitt F, May-Panloup P, Blagosklonov O, Brugnon F, Mestres S, Cabry R, Fauque P, Loup-Cabaniols V, Ravel C, Lévy R, Patrat C, Thibault E, Frydman N, Bujan L, Morinière C, Ducrocq B, Rives N. Fertility preservation and sperm donation in transgender individuals: the current situation within the French CECOS network. Andrology 2021; 9:1790-1798. [PMID: 34236139 DOI: 10.1111/andr.13075] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/29/2021] [Accepted: 06/29/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Many studies reported that reproductive desire could be high among transgender (TG) individuals. In France, fertility preservation (FP) and sperm donation were very little proposed to TG individuals until recently, mainly because the Bioethics Law allows the use of Assisted Reproductive Technologies (ART) only in infertile couples and prohibits surrogacy. OBJECTIVES To evaluate the distribution of care on the French territory concerning fertility preservation and sperm donation in TG individuals. MATERIALS AND METHODS A multicentric national survey was carried out between January 2019 and October 2020 in 28 ART centres of the French CECOS (Centres d'Etudes et de Conservation des Oeufs et du Sperme) network. Each centre was questioned to find out how many TG individuals came, were informed and cared for FP and sperm donation. RESULTS Concerning FP, 71.4% of centres received TG individuals and performed gamete cryopreservation; 581 TG individuals consulted for FP. TG women were more likely to desire (P<0.0001) and achieve (P<0.0001) FP than TG men. Concerning sperm donation in couples including a TG man, 68% of centres offer the complete course from the first consultation to the completion of the ART cycles; 122 offspring has been conceived with sperm donation in couples including a TG man since 1999. DISCUSSION Our results showed that even if all centres do not propose FP or sperm donation in TG individuals, these ART are present throughout the French territory. The major point is that both FP and sperm donation in TG individuals have grown significantly and that the care of these patients is improving year after year. CONCLUSION In France, most of CECOS centres can take care of TG individuals for FP and sperm donation. The French Bioethics law allows these latter, and TG individuals can benefit from a financial support of the national health care insurance for FP and sperm donation. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Florence Eustache
- Service D'Histologie-Embryologie, Cytogénétique, Biologie de La Reproduction / CECOS, Hôpitaux Universitaires Paris Seine-Saint-Denis, Site Jean Verdier, Bondy, France
| | - Véronique Drouineaud
- Service de Biologie de la Reproduction-CECOS, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP). Centre, Université de Paris, Paris, 75014, France
| | - Nicolas Mendes
- Service D'Histologie-Embryologie, Cytogénétique, Biologie de La Reproduction / CECOS, Hôpitaux Universitaires Paris Seine-Saint-Denis, Site Jean Verdier, Bondy, France
| | - Béatrice Delépine
- CECOS Champagne-Ardenne, Chu de Reims Hôpital d'Enfants, REIMS, Cedex, 51092, France
| | | | - Sophie Mirallié
- CECOS Pays de la Loire Nantes Service de Biologie de la reproduction, Nantes, Cedex 1, 44093, France
| | - Aline Papaxanthos
- CECOS Aquitaine, BORDEAUX Maternité CHU Pellegrin, Bordeaux, 33076, France
| | | | - Aurélie Rives-Feraille
- Normandie Univ, UNIROUEN, EA 4308 "Gametogenesis and Gamete Quality", Rouen University Hospital, Biology of Reproduction-CECOS Laboratory, Rouen, 76031, France
| | - Fanny Magnan
- Service D'Histologie-Embryologie, Cytogénétique, Biologie de La Reproduction / CECOS, Hôpitaux Universitaires Paris Seine-Saint-Denis, Site Jean Verdier, Bondy, France
| | - Cécile Grèze
- CECOS Alsace, STRASBOURG CMCO, Schiltighem, 67303, France
| | - Sylviane Hennebicq
- CECOS Rhône Alpes, GRENOBLE Hôpital Couple Enfant CHU GRENOBLE CEDEX 9, Cedex, France
| | - Isabelle Koscinski
- CECOS Lorraine Nancy, Maternité régionale Universitaire, Nancy, 54042, France
| | - Hortense Drapier
- Biologie de la Reproduction-CECOS, Hôpital de La Cavale Blanche, Brest, 29200, France
| | - Cynthia Frapsauce
- Service de Médecine et Biologie de la Reproduction-CECOS, CHRU Bretonneau, Tours, 37000, France
| | - Anne Mayeur
- CECOS Paris BECLERE, Hôpital Antoine Béclère, CLAMART, Cedex, 92140, France
| | | | - Joffrey Mons
- CECOS Océan Indien LA REUNION Centre, d'AMP CHU de La Réunion Saint- Pierre, Cedex, 97448, France
| | - Françoise Schmitt
- CECOS ALSACE Mulhouse Groupe Hospitalier, de la Région de Mulhouse et Sud Alsace, MULHOUSE, Cedex, 68070, France
| | - Pascale May-Panloup
- CECOS Pays de Loire, Antenne Angers, Laboratoire de Biologie de la Reproduction, Angers University Hospital, Angers, 49000, France
| | - Oxana Blagosklonov
- Service de Biologie et Médecine, de la Reproduction-Cryobiologie, CECOS CHRU Jean Minjoz, Besancon, 25030, France
| | - Florence Brugnon
- CECOS Auvergne, Clermont FERRAND CHU Estaing, CLERMONT FERRAND CEDEX 1, Clermont, 63003, France
| | - Stéphanie Mestres
- CECOS Auvergne, Clermont FERRAND CHU Estaing, CLERMONT FERRAND CEDEX 1, Clermont, 63003, France
| | | | | | - Vanessa Loup-Cabaniols
- CECOS Languedoc Roussillon, MONTPELLIER Hôpital Arnaud de Villeneuve, Montpellier, 34295, France
| | - Célia Ravel
- CECOS Bretagne, RENNES Hôpital Sud, Rennes, 35200, France
| | - Rachel Lévy
- CECOS Paris TENON Hôpital, Tenon, Paris, 75020, France
| | - Catherine Patrat
- Service de Biologie de la Reproduction-CECOS, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP). Centre, Université de Paris, Paris, 75014, France
| | - Emmanuelle Thibault
- CECOS Provence Alpes, Côte d'Azur NICE Centre de reproduction CHU de NICE, Nice, 06202, France
| | - Nelly Frydman
- CECOS Paris BECLERE, Hôpital Antoine Béclère, CLAMART, Cedex, 92140, France
| | - Louis Bujan
- CECOS Midi Pyrénées, TOULOUSE Hôpital Paule de Viguier, Toulouse, 31059, France
| | | | - Bérengère Ducrocq
- CECOS Nord LILLE CHRU, de LILLE Hôpital Calmette Lille, Cedex, 59037, France
| | - Nathalie Rives
- Normandie Univ, UNIROUEN, EA 4308 "Gametogenesis and Gamete Quality", Rouen University Hospital, Biology of Reproduction-CECOS Laboratory, Rouen, 76031, France
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16
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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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Sermondade N, Benaloun E, Berthaut I, Moreau E, Prades M, Béranger A, Chabbert-Buffet N, Johnson N, Lévy R, Dupont C. Reproductive functions and fertility preservation in transgender women: a French case series. Reprod Biomed Online 2021; 43:339-345. [PMID: 34144898 DOI: 10.1016/j.rbmo.2021.04.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 04/14/2021] [Accepted: 04/20/2021] [Indexed: 11/30/2022]
Abstract
RESEARCH QUESTION The reproductive potential of transgender people may be impaired by gender-affirming hormone treatment (GAHT) and is obviously suppressed by gender-affirming surgery involving bilateral orchiectomy. The evolution of medical support for transgender people has made fertility preservation strategies possible. Fertility preservation in transgender women mainly relies on sperm cryopreservation. There are few studies on this subject, and the sample sizes are small, and so it difficult to know whether fertility preservation procedures are feasible and effective in trans women. DESIGN This retrospective study reports the management of fertility preservation in transgender women referred to the study centre for sperm cryopreservation, and the semen parameters of trans women were compared with those of sperm donors. RESULTS Ninety-six per cent of transgender women who had not started treatment benefitted from sperm cryopreservation, compared with 80% of those who attempted a therapeutic window and 50% of those receiving hormonal treatment at the time of sperm collection. No major impairment of semen parameters was observed in transgender women who had not started GAHT compared with sperm donors. However, even though the frequency of oligozoospermia was no different, two transgender women presented azoospermia. Some transgender women who had started GAHT could benefit from sperm freezing. None of them were treated with gonadotrophin-releasing hormone (GnRH) analogues. CONCLUSIONS Parenthood strategies for transgender people have long been ignored, but this is an important issue to consider, especially because medical treatments and surgeries may be undertaken in adolescents or very young adults. Fertility preservation should ideally be offered prior to initiation of GAHT.
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Affiliation(s)
- Nathalie Sermondade
- Service de Biologie de la Reproduction CECOS, Hôpital Tenon (AP-HP), Sorbonne Université, Paris 75020, France; Sorbonne Université, Centre de Recherche Saint-Antoine, Inserm US938, Paris 75012, France
| | - Emmanuelle Benaloun
- Service de Biologie de la Reproduction CECOS, Hôpital Tenon (AP-HP), Sorbonne Université, Paris 75020, France
| | - Isabelle Berthaut
- Service de Biologie de la Reproduction CECOS, Hôpital Tenon (AP-HP), Sorbonne Université, Paris 75020, France
| | - Emilie Moreau
- Service de Biologie de la Reproduction CECOS, Hôpital Tenon (AP-HP), Sorbonne Université, Paris 75020, France
| | - Marie Prades
- Service de Biologie de la Reproduction CECOS, Hôpital Tenon (AP-HP), Sorbonne Université, Paris 75020, France
| | - Alix Béranger
- Service de Biologie de la Reproduction CECOS, Hôpital Tenon (AP-HP), Sorbonne Université, Paris 75020, France
| | - Nathalie Chabbert-Buffet
- Service de Gynécologie, Obstétrique et Médecine de la Reproduction, Hôpital Tenon (AP-HP), Sorbonne Université, 75020 Paris, France
| | - Nicolaï Johnson
- Service de Gynécologie, Obstétrique et Médecine de la Reproduction, Hôpital Tenon (AP-HP), Sorbonne Université, 75020 Paris, France
| | - Rachel Lévy
- Service de Biologie de la Reproduction CECOS, Hôpital Tenon (AP-HP), Sorbonne Université, Paris 75020, France; Sorbonne Université, Centre de Recherche Saint-Antoine, Inserm US938, Paris 75012, France
| | - Charlotte Dupont
- Service de Biologie de la Reproduction CECOS, Hôpital Tenon (AP-HP), Sorbonne Université, Paris 75020, France; Sorbonne Université, Centre de Recherche Saint-Antoine, Inserm US938, Paris 75012, France.
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18
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Yan M, Bustos SS, Kuruoglu D, Ciudad P, Forte AJ, Kim EA, Del Corral G, Manrique OJ. Systematic review of fertility preservation options in transgender patients: a guide for plastic surgeons. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:613. [PMID: 33987311 DOI: 10.21037/atm-20-4523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Transgender patients often desire to have biological children. However, their reproductive potential is often negatively impacted by gender affirming surgery (GAS) such as gender confirmation surgery (bottom surgery) and medical hormone therapy. Therefore, counselling patients on fertility preservation options before initiating gender-affirming treatments is prudent to avoid reducing their reproductive potential. A systematic review of English, Spanish, Chinese, French and Turkish languages from 2000 to December 23rd, 2019, using the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) guidelines, was conducted. The search strategy was designed and conducted by an experienced librarian with input from the study's principle investigator. Fifteen articles that report outcomes of fertility preservation options in transgenders were included. Eight articles described options for transgender women, six reported options for transgender men and one included both transgender women and transgender men. Semen cryopreservation and oocyte cryopreservation are the most common and available methods for fertility preservation in transgenders. Physician awareness of fertility preservation options in transgender patients is crucial to ensure informed discussions regarding reproductive options in the early phase of transition.
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Affiliation(s)
- Maria Yan
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Samyd S Bustos
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Center for Regenerative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Doga Kuruoglu
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Center for Regenerative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Pedro Ciudad
- Department of Plastic, Reconstructive and Burn Surgery, Arzobispo Loayza National Hospital, Lima, Peru
| | - Antonio J Forte
- Division of Plastic and Reconstructive Surgery, Mayo Clinic Florida Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Jacksonville, USA
| | - Esther A Kim
- Division of Plastic and Reconstructive Surgery, University of California, San Francisco, California, USA
| | - Gabriel Del Corral
- Department of Plastic Surgery, Medstar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Oscar J Manrique
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Center for Regenerative Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Amir H, Perl L, Barda S, Lantsberg D, Becker AS, Israeli G, Azem F, Oren A. Adolescent Transgender Females Present Impaired Semen Quality That Is Suitable for Intracytoplasmic Sperm Injection Even Before Initiating Gender-Affirming Hormone Treatment. Reprod Sci 2021; 29:260-269. [PMID: 33788173 DOI: 10.1007/s43032-021-00561-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/25/2021] [Indexed: 10/21/2022]
Abstract
The present study aimed to determine the semen quality and cryopreservation outcomes among adolescent transgender females at the time of fertility preservation (FP) before initiating gender-affirming hormone (GAH) treatment. This retrospective cohort study included 26 adolescent transgender females who underwent FP in our Fertility Institute between 06/2013 and 10/2020. Pre-freezing semen parameters were compared to WHO 2010 reference values. Post-thaw semen parameters were used to determine the adequate assisted reproductive technology (ART). A multivariate linear regression analysis was performed to assess the impact of medical and lifestyle factors on semen quality. The mean age at which adolescent transgender females underwent FP was 16.2 ± 1.38 years. The median values of all semen parameters in our study group were significantly lower compared to the WHO data, including volume (1.46 mL vs 3.2 mL, respectively, P = 0.001 ), sperm concentration (28 × 106/mL vs 64 × 106/mL, P < 0.001), total sperm number (28.2 × 106 vs 196 × 106, P < 0.001), total motility (51.6% vs 62%, P < 0.001), and normal morphology (2% vs 14%, P < 0.001). The frequency of semen abnormalities was teratozoospermia 72%, hypospermia 52%, oligozoospermia 28%, and azoospermia 4%. The median post-thaw total motile count was 0.17 × 106/vial, and the quality was adequate only for ICSI in 87.7% of the thawed semen samples. No correlation was found between selected medical and lifestyle factors and poor semen parameters. Semen quality is strongly reduced among adolescent transgender females before hormone therapy and their stored sperm samples are suitable for intracytoplasmic sperm injection (ICSI) rather than conventional IVF/intrauterine insemination (IUI).
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Affiliation(s)
- Hadar Amir
- Racine IVF Unit, Fertility Institute, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 6423906, Tel Aviv, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Liat Perl
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shimi Barda
- Racine IVF Unit, Fertility Institute, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 6423906, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Lantsberg
- Racine IVF Unit, Fertility Institute, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 6423906, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Segev Becker
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Galit Israeli
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Foad Azem
- Racine IVF Unit, Fertility Institute, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 6423906, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asaf Oren
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Building a Multidisciplinary Academic Surgical Gender-affirmation Program: Lessons Learned. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3478. [PMID: 33968551 PMCID: PMC8099415 DOI: 10.1097/gox.0000000000003478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 01/25/2021] [Indexed: 11/26/2022]
Abstract
Background: Every day, we see more patients present to hospitals and clinics seeking gender-affirmation care to ameliorate the symptoms of gender dysphoria. However, to provide a multidisciplinary approach, it is important to offer an integrated clinical program that provides mental health assessment, endocrine therapy, physical therapy, research, and the full spectrum of surgical services devoted to transgender patients. This article describes our experience on building a specialized, multidisciplinary, academic state-of-the-art gender-affirmation program. Methods: Herein, we describe the main and critical components on how to build a multidisciplinary academic gender-affirmation program. We share our lessons learned from this experience and describe how to overcome some of the obstacles during the process. Results: Building a multidisciplinary academic gender-affirmation program requires an invested team, as each and every member is essential for feedback, referrals, and to improve patient’s experience. Institutional support is essential and by far the most important component to overcome some of the obstacles during the process. Having all team members working under the same institution provides all the critical components needed to improve outcomes and patient satisfaction. In addition, the collection of prospective data with a well-structured research team will provide information needed to improve clinical services and standardize clinical protocols, while leaving space for innovation. Conclusions: This article describes the steps and experience needed to build a multidisciplinary holistic academic gender-affirmation program. We provide our lessons learned during the process that will help guide those who intend to start an academic gender-affirmation program.
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21
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Geist C, Greenberg KB, Luikenaar RAC, Mihalopoulos NL. Pediatric Research and Health Care for Transgender and Gender Diverse Adolescents and Young Adults: Improving (Biopsychosocial) Health Outcomes. Acad Pediatr 2021; 21:32-42. [PMID: 32980544 DOI: 10.1016/j.acap.2020.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 09/03/2020] [Accepted: 09/21/2020] [Indexed: 01/18/2023]
Abstract
Adolescent and young adult (AYA) transgender health care and research have expanded rapidly in the United States and abroad, but the effects of gender-affirming social, hormonal, or surgical care on overall health remain unclear. Gender diverse identities, also termed nonbinary, have often been neglected in favor of (male/female) binary identities, even in the context of transgender health care and research. No high quality studies have assessed how gender-affirming medical care impact health inequities in transgender and gender diverse (TG/GD) adults, much less in AYAs, despite the fact that that TG/GD adults have higher than average morbidity and mortality across a host of health concerns, from human immunodeficiency virus infection to thromboembolism, and that reported depression with suicidal ideation is >10 times higher in TG/GD adults than in the general population. TG/GD youth have related but different needs from TG/GD adults. TG/GD AYA are embedded in family and schools, where stigma may be difficult to escape; mental health during adolescence has areas of increased risk as well as resilience; and the effects of early hormonal and surgical interventions on long-term health are insufficiently studied. Because of this, an inclusive and proactive approach to addressing the needs of TG/GD AYA by pediatric clinicians, researchers, and educators is particularly crucial. This article focuses on what is known and unknown about clinical practice, research, and education related to TG/GD health. We highlight the role of gender affirmation by clinicians as they care and advocate for TG/GD AYAs; the potential challenges of hormonal treatment for peripubertal youth; and short- and long-term effects on physical and reproductive health of medical or surgical interventions. We also discuss how social context influences knowledge gaps and the health-relevant risks faced by TG/GD AYA. The challenges are formidable, but opportunities await: high priority research questions to explore, educational gaps to be filled, and advocacy that needs the voices of pediatricians to promote policies to facilitate positive health outcomes for TG/GD AYA.
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Affiliation(s)
- Claudia Geist
- Division of Gender Studies, Department of Sociology (C Geist), University of Utah, Salt Lake City, Utah
| | - Katherine B Greenberg
- Departments of Pediatrics and Obstetrics/Gynecology (KB Greenberg), University of Rochester, Rochester, NY
| | | | - Nicole L Mihalopoulos
- Department of Pediatrics (NL Mihalopoulos), University of Utah, Salt Lake City, Utah.
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22
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Roberts SA, Williams CR, Grimstad FW. Considerations for Providing Pediatric Gender-Affirmative Care During the COVID-19 Pandemic. J Adolesc Health 2020; 67:635-637. [PMID: 32943291 PMCID: PMC7489217 DOI: 10.1016/j.jadohealth.2020.08.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 08/16/2020] [Accepted: 08/17/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Stephanie A Roberts
- Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Coleen R Williams
- Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Frances W Grimstad
- Division of Gynecology, Boston Children's Hospital, Boston Massachusetts; Harvard Medical School, Boston, Massachusetts
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23
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Mayhew AC, Gomez-Lobo V. Fertility Options for the Transgender and Gender Nonbinary Patient. J Clin Endocrinol Metab 2020; 105:5892794. [PMID: 32797184 PMCID: PMC7455280 DOI: 10.1210/clinem/dgaa529] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/10/2020] [Indexed: 12/14/2022]
Abstract
Comprehensive care for transgender and gender nonbinary patients has been a priority established by the World Professional Association for Transgender Health. Because pubertal suppression, gender-affirming hormone therapy, and antiandrogen therapy used alone or in combination during medical transition can affect gonadal function, understanding the effects these treatments have on fertility potential is important for practitioners caring for transgender and gender nonbinary patients. In this review, we outline the impacts of gender-affirming treatments on fertility potential and discuss the counseling and the treatment approach for fertility preservation and/or family building in transgender and gender nonbinary individuals.
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Affiliation(s)
- Allison C Mayhew
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
- Children’s National Medical Center, Washington, DC
| | - Veronica Gomez-Lobo
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
- Children’s National Medical Center, Washington, DC
- Correspondence and Reprint Requests: Veronica Gomez-Lobo, MD, National Institute of Child Health and Human Development, Children’s National Medical Center, Division of Pediatric and Adolescent Gynecology, 10 Central Dr, Bldg 10, Rm 8N248, Bethesda, MD 20892, USA. E-mail:
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24
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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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25
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Jones NC, Otto AK, Ketcher DE, Permuth JB, Quinn GP, Schabath MB. Inclusion of transgender and gender diverse health data in cancer biorepositories. Contemp Clin Trials Commun 2020; 19:100597. [PMID: 32613134 PMCID: PMC7317667 DOI: 10.1016/j.conctc.2020.100597] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 06/04/2020] [Accepted: 06/14/2020] [Indexed: 02/08/2023] Open
Abstract
Biobanks have the potential to be robust resource for understanding potential cancer risks associated with gender-affirming interventions. In this narrative review, we synthesized the current published literature regarding the inclusion of TGD health data in cancer biorepositories and cancer research conducted on biospecimens. Of the 6986 initial results, 153 (2.2%) assessed the biological effects of gender-affirming interventions on TGD tissues. Within that category, only one paper examined transgender tissues in relation to cancer biobanks. Strategies are offered to address the inequities in TGD tissue-based research and diversify the field of biobanking as a whole.
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Affiliation(s)
- Nat C Jones
- University of South Florida, Morsani College of Medicine, Tampa, FL, USA.,H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Amy K Otto
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Dana E Ketcher
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | | | - Matthew B Schabath
- University of South Florida, Morsani College of Medicine, Tampa, FL, USA.,H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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26
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Manuel SL, Moravek MB, Confino R, Smith KN, Lawson AK, Klock SC, Pavone ME. Ovarian stimulation is a safe and effective fertility preservation option in the adolescent and young adult population. J Assist Reprod Genet 2019; 37:699-708. [PMID: 31828481 DOI: 10.1007/s10815-019-01639-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 11/21/2019] [Indexed: 01/23/2023] Open
Abstract
PURPOSE The aim of this study is to describe the multidisciplinary approach and controlled ovarian hyperstimulation (COH) outcomes in adolescent and young adult (AYA) patients (ages 13-21) who underwent oocyte cryopreservation for fertility preservation (FP). METHODS Multi-site retrospective cohort was performed from 2007 to 2018 at Northwestern University and Michigan University. Data were analyzed by chi-square test, t-test, and logistic regression. RESULTS Forty-one patients began COH of which 38 patients successfully underwent oocyte retrieval, with mature oocytes obtained and cryopreserved without any adverse outcomes. To treat this group of patients, we use a multidisciplinary approach with a patient navigator. When dividing patients by ages 13-17 vs. 18-21, the median doses of FSH used were 2325 and 2038 IU, the median number of mature oocytes retrieved were 10 and 10, and median number frozen oocytes were 11 and 13, respectively. Median days of stimulation were 10 for both groups. There was no statistical difference in BMI, AMH, peak E2, FSH dosage, days stimulated, total oocytes retrieved, mature oocytes retrieved, and oocytes frozen between the two groups. Three patients were canceled for poor response. CONCLUSION COH with oocyte cryopreservation is a feasible FP option for AYAs who may not have other alternatives when appropriate precautions are taken, such as proper counseling and having a support team. These promising outcomes correspond to similar findings of recent small case series, providing hope for these patients to have genetically related offspring in the future.
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Affiliation(s)
- Sharrόn L Manuel
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Ave, Suite 2310, Chicago, IL, 60611, USA
| | - Molly B Moravek
- Department of Obstetrics & Gynecology, University of Michigan Health System, Ann Arbor, MI, 48109, USA
| | - Rafael Confino
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Ave, Suite 2310, Chicago, IL, 60611, USA
| | - Kristin N Smith
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Ave, Suite 2310, Chicago, IL, 60611, USA
| | - Angela K Lawson
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Ave, Suite 2310, Chicago, IL, 60611, USA
| | - Susan C Klock
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Ave, Suite 2310, Chicago, IL, 60611, USA
| | - Mary Ellen Pavone
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Ave, Suite 2310, Chicago, IL, 60611, USA.
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27
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Rafferty J. Fertility Preservation Outcomes and Considerations in Transgender and Gender-Diverse Youth. Pediatrics 2019; 144:peds.2019-2000. [PMID: 31383815 DOI: 10.1542/peds.2019-2000] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/27/2019] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jason Rafferty
- Thundermist Health Centers, Woonsocket, Rhode Island; Hasbro Children's Hospital, Providence, Rhode Island; and Emma Pendleton Bradley Hospital, East Providence, Rhode Island
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