A Pilot Study to Assess Attitudes Toward Future Fertility and Parenthood in Transgender and Gender Expansive Adolescents

Abstract

In this pilot study, we sought to characterize the knowledge about fertility and attitudes about future parenthood in a sample of transgender and gender expansive (TGE) youth attending an academic, universityaffiliated adolescent gender program. Methods: A 22-item cross-sectional survey assessing knowledge of fertility issues and attitudes toward future parenthood was administered to 23 transgender adolescents, 12-22 years of age, who reported gender identity incongruent with birth-assigned sex, and who were seen at our university-affiliated clinic during an 11-month period between October 2016 and August 2017. Knowledge scores and ranked responses on selected topics in fertility and reproduction were evaluated. Results: Participants were well informed overall about fertility topics related to their gender care (mean score of 3.8-0.8 out of 5), but over half of participants lacked specific knowledge regarding basic fertility principles and overestimated the ability of physicians to predict the effects of gender-affirming hormone therapy on fertility. The majority of participants (15/23) preferred nonbiological parenthood in the form of adoption. Participants who ranked future parenthood as unimportant had the greatest concern about becoming a parent (p < 0.05), and over one-third were also concerned about interrupting their gender-affirming hormone therapy to preserve fertility. Conclusion: TGE youth would benefit from fertility-related counseling that both assesses baseline understanding of reproduction and also acknowledges the limitations of current data on gender-affirming hormones and future fertility. Counseling should also be comprehensive and explore both biological and nonbiological forms of parenthood.

Update on bioethical, medical and fertility issues in gender incongruence during transition age

“…Recovery of spermatogenesis is possible after treatment discontinuation, but neither the recovery time nor the effects of therapy on offspring are known Adeleye et al 2019 [ 71 ] Barnard et al 2019 [ 72 ] Sermondade et al 2021 [ 60 ] Use of FP among transgender youth, barriers to the use of FP for transgender youth and their desire of parenthood It is observed low adherence to fertility preservation. The reason is related to barriers such as cost, inadequate access to medical care, inconvenience in retrieving gametes, and concern in delaying treatment Chen et al 2017 [ 75 ] Nahata et al 2017 [ 76 ] Kyweluk et al 2018 [ 80 ] Chiniara et al 2019 [ 73 ] Morrison et al 2020 [ 74 ] Persky et al 2020 [ 81 ] Kerman et al 2021 [ 57 ] McCallion et al 2021 [ 77 ] Boguszewski et al 2022 [ 78 ] How to improve the clinical practice Providers suggest that the presence of a disciplinary team, providing written information, personalizing the approach and developing a decision aid programme could improve clinical practice Johnson et al 2016 [ 86 ] Chen et al 2018 [ 82 ] Chen et al 2019 [ 85 ] Lai et al 2021 [ 83 ] Quain et al 2021 [ 84 ] …”

“…Some recent studies have reported that fertility is not a priority for transgender youth [73,74] and it is observed low adherence to fertility preservation [75][76][77] with less than 5% of transgender youth pursue cryopreservation [73,74]. Other studies reported fertility preservation rates widely variable in youth from < 5% to 40% [19].…”

Development and Pilot Testing of the Transgender and Gender Diverse Fertility Preservation Knowledge Scale

“…These components are critical when patients are facing difficult, life altering decisions, such as those faced at the time of gender affirmation 41 . As fertility preservation is considered a preference sensitive healthcare decision [6][7][8] , empowering the TGD person to identify and act upon their treatment preferences is pivotal in TGD patient fertility preservation counseling.…”

“…Though a comprehensive discussion of treatment options specific to fertility preservation is beyond the scope of this manuscript, individual healthcare treatment decisions within the TGD population may vary widely based on personal preferences. As a result, decisions around fertility preservation would be considered preference sensitive, meaning they should be made based upon how treatment options would be experienced by the individual [6][7][8] . These equipoise healthcare decisions occur in situations where evidence of superiority of one treatment over another is dependent upon how the individual values the risks and benefits of each treatment option 9 .…”

“…The concept of parenthood in the TGD client is often variable and individually negotiated with their personal identity 8,26 . Historically, it has been assumed by many that seeking healthcare for gender affirmation eliminated the possibility of biologic children 6,11 and further, that most transgender individuals do not want children 11,27 .…”