Fertility desires and reproductive needs of transgender people: Challenges and considerations for clinical practice

Abstract

The majority of transgender and gender nonconforming persons seeking medical care are of reproductive age. Hormonal treatment and sex reassignment surgery, which are used in the management of gender dysphoria, compromise fertility potential. Children and adolescents with gender dysphoria have specific treatment regimens starting with puberty-blocking medications. According to international guidelines, fertility preservation should be discussed before any hormonal treatment, although our knowledge on the reproductive needs of transgender and gender nonconforming persons is limited. Recently, some data have emerged on fertility management in some centres for the adult population with gender dysphoria. The goal of this review was to summarize the available evidence on the fertility desires and parental roles of transgender and gender nonconforming people. In light of newly emerging societal challenges, we aim to provide some considerations for clinical practice and suggest further areas of research. K E Y W O R D S fertility desires, gender dysphoria, parentality | 11 FEIGERLOVÁ Et aL.

Fertility preservation and sperm donation in transgender individuals: The current situation within the French CECOS network

“…3 Having a child for TG individuals can be difficult because GAHT or GAS can compromise future fertility. 4 Currently, no sufficient data are available to evaluate the long-term reproductive effects of GAHT, the reversibility and the delay from discontinuation of GAHT to fertility recovery. In TG women, most studies reported cytological alterations of spermatogenesis leading to semen parameter alterations during GAHT with no specific data on the reversibility of GAHT's reproductive effects.…”

Maternal Health in the Transgender Population

“…Unfortunately, a large portion of the transgender community believes that testosterone use represents a contraceptive measure. 3 In a cohort of 197 transgender men, 16% used testosterone as contraception, and 5.5% said health care providers had advised them this was a reliable method. 26 The total number of pregnancies in transgender men is unknown, but studies suggest that pregnancy rates range from 5% to 17% in adolescents and adults.…”

“…2 If an individual's gender identity does not fit within the male/female dichotomy, the description ''nonbinary gender identity'' can be applied. 3 Gender dysphoria is defined as the distress experienced when gender identity and designated gender are not completely congruent. 2 A TGNC person may choose to ''transition'' or change their physical, social, and legal characteristics to align with the identified gender.…”

Characteristics and intentions of heterosexual couples comprising a transgender man awaiting sperm donation to conceive a child

“…8 Unfortunately, the treatment options to facilitate gender transition include medical interventions that can have deleterious effects on fertility. 10 Consequently, most TG people require assisted reproductive technologies (ART), which depend on many factors, such as the gender of the partner, the timing of the ART in relation to the GAMIs, and the legislation applicable in their country of residence. 11 Additionally, TG people are often also interested in the possibility of using fertility preservation.…”