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

Ethical Concerns

Historically, a central ethical concern has been whether it is acceptable to help transgender individuals reproduce.[2] It has been argued that transgender people are mentally unfit to parent, and thus, should be denied access to reproductive services.[65] In fact, there are sterilization provisions in many countries that are promoted under the argument of protecting child welfare.[7] Twenty countries in Europe continue to enforce a sterilization requirement for transgender individuals who apply for gender recognition, which forces them to either give up their reproductive capabilities or surrender their right to be acknowledged by their preferred gender.[7] The argument that trans people are not fit to be parents is outdated, discriminatory, and not evidence based.[2] Studies on the children of transgender parents have found no effect on the gender identity or sexual orientation of the children of trans people, nor is there any evidence that the well-being of the children is compromised in any way.[14,61]

There are several other ethical issues as well. First of all, the risks of long-term exposure to hormones by transgender individuals is not understood, and thus, any potential risks to the patient or future offspring is unknown. Also, offering any services that are currently experimental could cause harm to the patient, given that they are only available under a research protocol and the risks are still unclear.

In the pediatric population, there are ethical issues regarding the patient's ability to participate in medical decision-making, especially when they are asked to make potentially irreversible fertility decisions as a minor.[21] It can also be challenging when the desires of the parents and child are different. From the provider's standpoint, it is also important to set realistic expectations with the patient and family given that the options for FP in prepubertal children are experimental.[21] Prepubertal transgender children may be forced to choose whether they want to experience permanent changes to their body associated with puberty or whether they want to transition and risk irreversible infertility.[64] The ASRM recommends that any decisions regarding gonadectomy be delayed until the individual is an adult.[2]

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