Abstract
BackgroundGender-affirming hormone therapy has been hypothesized to reduce the patient’s reproductive potential in transmen, although the exact long-term effects on future fertility are unknown.MethodsIn this prospective cohort study we aimed to evaluate ovaries of 20 transmen by using hormone serum levels, histomorphological analysis and fluorescence activated cells sorting (FACS) analysis – in order to assess the amount of vital cells.ResultsThe median total number of follicles per field of view was 39 (IQR 12–122). Of all follicles (n = 1661), the vast majority was primordial (n = 1505, 90.6%), followed by primary (n = 76, 4.6%), abnormal (n = 63, 3.8%) and secondary follicles (n = 17, 1.0%). FACS analysis was available for 13 samples (65.0%) and the median frequency of vital cells was 87.5% (IQR, 77.7–95.4%). Both a higher age (p = 0.032) and a lower BMI (p = 0.003) were significantly associated with a higher frequency of vital cells.ConclusionThe majority of ovarian cells after long-term androgen treatment were vital in FACS analysis and histomorphological evaluation revealed a normal cortical follicle distribution. These results are currently exploratory, but might be promising for issues on fertility preservation.Trial registrationThe study was approved by the ethics committee of the Medical University of Vienna (EK 2240/2016) and was retrospectively registered in the Current Controlled Trials Register (registration number NCT03649087, date of registration: 28.08.2018).
Highlights
Gender-affirming hormone therapy has been hypothesized to reduce the patient’s reproductive potential in transmen, the exact long-term effects on future fertility are unknown
A similar analysis was performed for the frequency of abnormal follicles (Table 2), where a higher rate of abnormal follicles was associated with lower testosterone (ß = − 1.2 ± 0.6; p = 0.044) as well as lower follicle stimulating hormone (FSH) levels (ß = − 1.8 ± 0.4; p < 0.001)
The follicle count was not a predictor of the number of vital cells in fluorescence activated cells sorting (FACS) analysis, which could be seen as a hint that a majority of vital cells derived from the ovarian stroma, which is in line with the considerations above
Summary
Gender-affirming hormone therapy has been hypothesized to reduce the patient’s reproductive potential in transmen, the exact long-term effects on future fertility are unknown. The quality of life of affected patients, namely transmen and transwomen, is substantially reduced (Newfield et al 2006; Valashany and Janghorbani 2018). Maintenance of the reproductive potential definitely is a hot topic for transmen. That transgender patients should have equal access to fertility options as cisgender individuals has been clearly stated by both the American Society for Reproductive Medicine and the European Society of Human Reproduction and Embryology. Options for fertility preservation should be discussed before gender transition (De Wert et al 2014; Ethics Committee of the American Society for Reproductive M 2015). It has been reported that more than half of transgender men would have desired to have children (Wierckx et al 2012) and, according to another study, 76% of both transgender men and women had thought about fertility preservation before the initiation of the transition process (Auer et al 2018)
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