Fertility Concerns of the Transgender Patient

Philip J. Cheng; Alexander W. Pastuszak; Jeremy B. Myers; Isak A. Goodwin; James M. Hotaling

Disclosures

Transl Androl Urol. 2019;8(3):209-218. 

In This Article

Fertility Desires for Transgender Individuals

There is a widespread assumption that transgender people do not want to have biological children.[7] On the contrary, several studies have shown that many transgender individuals want biological children.[7–11] One study of 50 transmen showed that 54% desired children.[12] Similarly, in a survey of 121 transwomen, 51% would have strongly considered or undergone sperm cryopreservation if they had been given the option by a provider.[13] A review of 51 studies examining the prevalence and characteristics of transgender parents showed that in the majority of studies, 25–50% of transgender people reported being parents.[14] People who "come out" or transition later in life tend to have higher parenting rates than those who transitioned at younger ages, likely due to individuals having children with a partner before identifying as transgender.[14] Now that acceptance of the transgender population has become more widespread and gender-affirming treatment is increasingly covered by insurance, transgender individuals have started to seek treatment at a younger age, when reproductive wishes may not yet be clearly defined and many may wish to have children after transition.[5,6,12,15]

Though a few studies have shown there is a strong desire by transgender adults to have biological children, that desire seems to be less pronounced among transgender youth. In a study by Nahata et al. examining 73 post-pubertal transgender patients who presented to a pediatric endocrinology clinic for hormone therapy, 72 had documented fertility counseling prior to initiation of hormone therapy, though only 2 patients attempted FP.[16] Of these 73 patients, 45% mentioned a desire or plan to adopt, while 21% said they never wanted to have children.[16]

Some studies have shown that individuals that identify as lesbian, gay, bisexual, transgender, and queer (LGBTQ) are more open to alternative methods of family building compared with heterosexuals. In a study comparing adolescent and young adult LGBTQ and heterosexual cancer survivors, LGBTQ individuals were more open to raising non-biological children or to not having children than heterosexuals.[17] Another study of 156 transgender and gender-nonconforming adolescents showed that 70.5% were interested in adoption, while only 35.9% were interested in biological parenthood.[18] Of note, only 20.5% had discussed fertility with a healthcare provider and only 13.5% discussed effects of hormones on fertility. Another study by Chen et al. of 105 transgender adolescents who presented to a pediatric gender clinic, only 13 (12.4%) were seen in formal consultation for FP before initiating hormones, 5 of which utilized FP services.[19]

A possible explanation for the low utilization of FP among transgender youth could be that they do not want to delay medical transition.[19] Other barriers include the cost and invasiveness of procedures. It is possible that transgender youth may change their perspectives about FP later in life, which makes it all the more important to counsel these patients effectively before initiating treatment that could have potentially irreversible effects on fertility.

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