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.
Highlights
Gender variance, referred to as gender expansiveness, is a situation in which a person’s sex assigned at birth is incongruous with the gender with which they identify [1, 2]
This study sought to assess the fertility preservation utilization rate when services were offered as part of a multidisciplinary pediatric gender clinic team, compared to previous studies when external referrals were provided
Of the 184 eligible patients seen during the study period, 132 met inclusion criteria (Fig 1)
Summary
Referred to as gender expansiveness, is a situation in which a person’s sex assigned at birth is incongruous with the gender with which they identify [1, 2]. With increased awareness of gender variance and transgender and non-binary people, these individuals are receiving easier access to care and earlier hormonal interventions. These gender-affirming therapies include puberty-suppressing gonadotropin-releasing hormone agonists (GnRHa) and sex hormone therapy (estrogen for those desiring feminine secondary sex characteristics and testosterone for those desiring masculine secondary sex characteristics). Gender-affirming therapies may include surgical interventions such as top surgery (breast augmentation or chest reduction), and gonadectomy These therapies are potentially available to all non-binary and transgender individuals, an individual may decide to pursue some or all of these treatment modalities depending on their specific goals [1, 6]
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