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Nguyen NH, Kim H, Tran C, Sumida M, Lansdowne E, Galzote-Carino R. Developmental uterovaginal anomalies and histologic findings in transgender patients receiving gender-affirming hysterectomies: A large case series. Int J Gynaecol Obstet 2024. [PMID: 38706397 DOI: 10.1002/ijgo.15582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/11/2024] [Accepted: 04/22/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVE To describe the incidence of uterovaginal anomalies and histologic findings in transgender and nonbinary (TGNB) patients seeking hysterectomies. METHODS All patients receiving gender-affirming hysterectomies between 2013 and 2023 were retrospectively reviewed. Primary outcomes included uterovaginal anomalies and histological findings. Multivariable logistic regressions were performed to evaluate relationships between variables of interest and whether they predict findings of uterovaginal anomalies, inactive endometrium, adenomyosis, leiomyoma, endometriosis, and cervical atrophy. RESULTS 278 patients received hysterectomies at an average age of 29.2 ± 8.3 years. Seven patients (2.5%) were found to have a developmental anomaly, including two bicornuate uterus (0.7%), two unicornuate uterus (0.7%), one septate uterus (0.4%), and two vaginal septum (0.7%). 60 patients (21.6%) were found to have inactive endometrium and 26 patients (9.4%) had cervical atrophy. Although 262 patients (94.2%) were on testosterone therapy, hormone duration was not a significant predictor of any uterine findings. CONCLUSION This study describes uterovaginal anomalies in a large cohort of patients receiving gender-affirming hysterectomies. Although long-term testosterone use is commonly believed to be associated with endometrial and cervical atrophy, this study shows no such association.
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Affiliation(s)
- Nghiem H Nguyen
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
| | - Hoejeong Kim
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
| | - Christina Tran
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
| | - Megan Sumida
- Department of Obstetrics and Gynecology, Kaiser Permanente Southern California Medical Group, Los Angeles, California, USA
| | - Elisa Lansdowne
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
- Department of Obstetrics and Gynecology, Kaiser Permanente Southern California Medical Group, Los Angeles, California, USA
| | - Rosanna Galzote-Carino
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
- Department of Obstetrics and Gynecology, Kaiser Permanente Southern California Medical Group, Los Angeles, California, USA
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2
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Falck FAOK, Dhejne CMU, Frisén LMM, Armuand GM. Subjective Experiences of Pregnancy, Delivery, and Nursing in Transgender Men and Non-Binary Individuals: A Qualitative Analysis of Gender and Mental Health Concerns. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:1981-2002. [PMID: 38228983 PMCID: PMC11106200 DOI: 10.1007/s10508-023-02787-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 01/18/2024]
Abstract
Studies of how gender-diverse individuals experience pregnancy, childbirth, and nursing remain few, mainly focus on the US and contain scarce information about mental health concerns peri-partum. This hinders informed reproductive health decisions and counseling. We used in-depth interviews to examine how gestational gender-diverse individuals in Sweden experience the process of planning and undergoing pregnancy, delivery, and nursing. In total, 12 participants, identifying on the masculine side of the gender spectrum or as non-binary, who had attended Swedish antenatal care and delivered a live birth, were included in the study. Data were analyzed using qualitative thematic content analysis. The analysis resulted in one overarching theme: sustaining gender congruence during pregnancy and three main categories: (1) considering pregnancy; (2) undergoing pregnancy and childbirth; and (3) postnatal reflections. The association between childbearing and being regarded as female permeated narratives. Participants renegotiated the feminine connotations of pregnancy, accessed gender-affirming treatment, and concealed their pregnancy to safeguard their gender congruence. Mis-gendering and breast enlargement triggered gender dysphoria. Social judgment, loneliness, information shortages, hormonal influence and cessation of testosterone increased gender dysphoria and strained their mental health. Depression exacerbated gender dysphoria and made it harder to claim one's gender identity. Dissociation was used to handle a feminized body, vaginal delivery, and nursing. Pregnancy was easier to envision and handle after masculinizing gender-affirming treatments. The results deepen the understanding of gender dysphoria and may be used to inform reproductive counseling and healthcare development. Research outcomes on mental health concerns provide a basis for further research.
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Affiliation(s)
- Felicitas A O K Falck
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
- ANOVA, Karolinska University Hospital, 171 76, Stockholm, Sweden.
- Psychiatry Southwest, Karolinska University Hospital in Huddinge, Stockholm, Sweden.
| | - Cecilia M U Dhejne
- ANOVA, Karolinska University Hospital, 171 76, Stockholm, Sweden
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Louise M M Frisén
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Gabriela M Armuand
- School of Health and Welfare, Faculty of Health Sciences 1, Dalarna University, Falun, Sweden
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Pamulapati S, Conroy M, Cortina C, Harding E, Kamaraju S. Systematic Review on Gender-Affirming Testosterone Therapy and the Risk of Breast Cancer: A Challenge for Physicians Treating Patients from Transgender and Gender-Diverse Populations. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:1969-1980. [PMID: 38148450 DOI: 10.1007/s10508-023-02773-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 11/29/2023] [Accepted: 11/29/2023] [Indexed: 12/28/2023]
Abstract
Conflicting evidence exists about the risk of breast cancer in transgender and gender-diverse (TGD) patients treated with testosterone. This review aimed to summarize current knowledge regarding the risk of breast cancer associated with gender-affirming testosterone treatment (GATT). A systematic literature search using the Preferred Reporting Items for Systematic Review and Meta-Analysis checklist was conducted in January 2023 through Ovid, Scopus, and Web of Science databases. English-language, peer-reviewed articles evaluating breast cancer in TGD patients after GATT that met the inclusion criteria were included. This review included 22 articles, with 14 case reports, 4 case series, and 4 retrospective cohort studies. The review identified 26 TGD patients who developed breast cancer post-GATT therapy, with inconclusive evidence on the relationship between testosterone and the risk of breast cancer in TGD patients. This uncertainty in part arises from the mechanisms governing testosterone's effects within breast tissue, with contrasting theories proposing both proliferative and antiproliferative impacts. Considering this ambiguity, it is imperative for healthcare providers to engage in informed discussions with patients prior to initiating hormone therapy to discuss potential adverse effects, including the possibility of breast cancer development in TGD individuals. Patient education and shared decision-making are essential components of responsible care in this context.
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Affiliation(s)
- Saagar Pamulapati
- Mercyhealth Javon Bea Hospital, 2400 N Rockton Ave., Rockford, IL, 61103, USA.
| | - Meghan Conroy
- Medical Education, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Chandler Cortina
- Medical Education, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Eric Harding
- Clinical Services Librarian, Froedtert Hospital, Milwaukee, WI, USA
| | - Sailaja Kamaraju
- Medical Education, Medical College of Wisconsin, Milwaukee, WI, USA
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4
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Sundaram V, Stark B, Jaswa E, Letourneau J, Mok-Lin E. Decision regret, and other mental health outcomes, following fertility preservation in the transgender individual compared to the cisgender woman. J Assist Reprod Genet 2024; 41:1077-1085. [PMID: 38332415 PMCID: PMC11052947 DOI: 10.1007/s10815-023-03013-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 12/20/2023] [Indexed: 02/10/2024] Open
Abstract
PURPOSE This study aimed to (1) determine differences in depression, anxiety, body image, quality-of-life (QOL), and decision regret scale (DRS) scores in transgender individuals undergoing fertility preservation (FP) compared to those who decline and (2) determine if DRS score following FP varies between transgender individuals and cisgender women. METHODS Sixteen transgender birth-assigned (BA) females and 13 BA males, undergoing FP consultation at an academic center between January 2016 and November 2019, were compared to each other and cisgender cohorts with pre-existing data: 201 women undergoing elective oocyte cryopreservation (EOC) between 2012 and 2016 and 44 women with cancer undergoing FP between 1993 and 2007. Outcomes included demographics; validated scales for depression, anxiety, body image, QOL (see below) in the trans cohort; DRS score in all three cohorts. RESULTS Of 29 transgender individuals participating, 10 BA females (62%) and 12 BA males (92%) underwent FP. Beck Depression Inventory II, Hospital Anxiety and Depression Scale, Body Image Scale for Transsexuals, Satisfaction with Life Scale, Short Form Health Survey-36, and DRS scores were not significantly different between trans individuals who underwent FP and those who declined. On univariate modeling, regret was significantly lower in transpeople undergoing FP compared to those who did not (OR 0.118, p = 0.03). BA female and BA male transpatients undergoing FP reported DRS median scores 5 (mean 9) and 7.5 (mean 15), respectively, both were not significantly different from cisgender women (p = 0.97, p = 0.25) nor from each other (p = 0.43). CONCLUSIONS Depression, anxiety, body image, and QOL, in a group of individuals presenting for FP consultation, appear similar between transpeople undergoing FP and not, while regret is significantly lower in those choosing FP. FP is an option for transgender individuals without significant differences in regret compared to cisgender women.
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Affiliation(s)
- Viji Sundaram
- Florida Institute for Reproductive Medicine, 836 Prudential Dr, Suite 902, Jacksonville, FL, 32207, USA.
| | - Brett Stark
- University of California, San Francisco, 499 Illinois St, San Francisco, CA, 94158, USA
| | - Eleni Jaswa
- University of California, San Francisco, 499 Illinois St, San Francisco, CA, 94158, USA
| | | | - Evelyn Mok-Lin
- University of California, San Francisco, 499 Illinois St, San Francisco, CA, 94158, USA
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5
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Johnson A, McClurg AB, Baldino J, Das R, Carey ET. Fertility preservation choices and decisional regret after gender-affirming surgery in transgender men or gender nonbinary persons. F S Rep 2024; 5:87-94. [PMID: 38524213 PMCID: PMC10958706 DOI: 10.1016/j.xfre.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/06/2023] [Accepted: 12/12/2023] [Indexed: 03/26/2024] Open
Abstract
Objective To investigate the prevalence of decisional regret regarding preoperative fertility preservation choices after gender-affirming surgery or removal of reproductive organs. Design Cross-sectional. Setting University-based pratice. Patients A total of 57 survey respondents identifying as transgender men or gender nonbinary with a history of gender-affirming surgery or removal of reproductive organs between 2014 and 2023 with the University of North Carolina Minimally Invasive Gynecology division. Intervention Survey or questionnaire. Main Outcome Measures The prevalence and severity of decisional regret regarding preoperative fertility preservation choices were measured with the use of the validated decisional regret scale (DRS) (scored 0-100). Secondary outcomes included patient-reported barriers to pursuing reproductive endocrinology and infertility consultation and fertility preservation treatment. Results The survey response rate was 50.9% (57/112). "Mild" to "severe" decisional regret was reported by 38.6% (n = 22) of survey respondents, with DRS scores among all respondents ranging from 0-85. Higher median DRS scores were associated with patient-reported inadequacy of preoperative fertility counseling regarding implications of surgery on future fertility or family-building (0 vs. 50) and fertility preservation options (0 vs. 12.5). No desire for future fertility at the time of fertility counseling was the most frequent reason (68.4%) for declining a referral to reproductive endocrinology and infertility for additional fertility preservation discussion. Conclusions Decisional regret regarding preoperative fertility preservation choices is experienced among transgender men or gender nonbinary persons after gender-affirming surgery or the removal of reproductive organs. Preoperative, patient-centered fertility counseling and fertility preservation treatments should be provided to reduce the risk of future regret.
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Affiliation(s)
- Austin Johnson
- Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington
| | - Asha B. McClurg
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Janine Baldino
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Rajeshree Das
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Erin T. Carey
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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White J, Jackson A, Druce I, Gale J. Oocyte cryopreservation and reciprocal in vitro fertilization in a transgender man on long term testosterone gender-affirming hormone therapy: a case report. F S Rep 2024; 5:111-113. [PMID: 38524208 PMCID: PMC10958692 DOI: 10.1016/j.xfre.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 10/21/2023] [Accepted: 11/06/2023] [Indexed: 03/26/2024] Open
Abstract
Objective To report a successful case of oocyte cryopreservation and subsequent in vitro fertilization (IVF) in a transgender male receiving continued testosterone gender-affirming hormone therapy, followed by reciprocal embryo transfer (ET). Design A case report of a rare case of fertility preservation in a transgender man with concomitant use of testosterone therapy for 4 years before and during ovarian stimulation. Setting Private fertility clinic with university affiliation. Patients A 26-year-old transgender man undergoing oocyte cryopreservation before gender-affirming surgery. Interventions Fertility preservation using oocyte cryopreservation and IVF with reciprocal fresh ET into a cisfemale partner. Main Outcome Measures Successful oocyte cryopreservation, oocyte thawing, and reciprocal IVF cycle. Results Oocyte cryopreservation of 29 mature oocytes. Sixteen mature oocytes survived the thaw, and 12 were fertilized with intracytoplasmic sperm injection. A fresh ET of an advanced blastocyst resulted in a clinical pregnancy and live birth. Conclusions Fertility preservation with oocyte cryopreservation or IVF with embryo cryopreservation is feasible for patients on continued long-term testosterone gender-affirming therapy. Future studies on egg quality and reproductive outcomes are required. Our case report demonstrates a promising outcome in this patient population.
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Affiliation(s)
- Justin White
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Fertilty Centre, Ottawa, Ontario, Canada
| | - Aaron Jackson
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Fertilty Centre, Ottawa, Ontario, Canada
| | - Irena Druce
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Jenna Gale
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Fertilty Centre, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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7
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Raja NS, Rubin ES, Moravek MB. A Review of Animal Models Investigating the Reproductive Effects of Gender-Affirming Hormone Therapy. J Clin Med 2024; 13:1183. [PMID: 38398495 PMCID: PMC10889210 DOI: 10.3390/jcm13041183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 02/08/2024] [Accepted: 02/10/2024] [Indexed: 02/25/2024] Open
Abstract
Gender-affirming hormone therapy (GAHT) is an important component in the process of transitioning for many transgender and gender-diverse (TGD) individuals. Multiple medical organizations recommend fertility preservation counseling prior to initiation of GAHT; however, there remains little high-quality data regarding the impact of GAHT on fertility and reproductive function. A PubMed literature review was performed using Boolean search operators linking keywords or phrases such as "mouse", "rat", "primate", "animal model", "transgender", "gender", "estrogen", "testosterone", "fertility", and "fertility preservation". Recent research has produced a number of animal models of GAHT that utilize similar hormonal regimens and produce similar phenotypic results to those used and observed in human patients. Specific to testosterone(T)-containing GAHT, animals demonstrate loss of menstrual cyclicity with therapy, resumption of menses on cessation of therapy, suppression of gonadotropin levels, and physical changes such as clitoromegaly. Models mimicking GAHT for transmasculine individuals in the peripubertal period demonstrate that pretreatment with GnRHa therapy does not modify the effects of subsequent T administration, which were similar to those described in adult models. Both models suggest promising potential for future fertility with cessation of T. With estradiol (E)-containing GAHT, animals exhibit decreased size of testicles, epididymis, and seminal vesicles, as well as ongoing production of spermatocytes, and seminiferous tubule vacuolization. Given the ethical challenges of conducting human studies in this area, high-fidelity animal models represent a promising opportunity for investigation and could eventually transform clinical counseling about the necessity of fertility preservation. Future studies should better delineate the interactions (if any exist) between treatment attributes such as dosing and duration with the extent of reversibility of reproductive perturbations. The development of models of peripubertal feminizing GAHT is an additional area for future work.
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Affiliation(s)
- Nicholas S. Raja
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Elizabeth S. Rubin
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR 97239, USA;
| | - Molly B. Moravek
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI 48109, USA;
- Department of Urology, University of Michigan, Ann Arbor, MI 48109, USA
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8
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Ghofranian A, Aharon D, Friedenthal J, Hanley WJ, Lee JA, Daneyko M, Rodriguez Z, Safer JD, Copperman AB. Family Building in Transgender Patients: Modern Strategies with Assisted Reproductive Technology Treatment. Transgend Health 2024; 9:76-82. [PMID: 38312448 PMCID: PMC10835155 DOI: 10.1089/trgh.2021.0210] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose Transgender and gender diverse (TGD) individuals continue to face adversity, stigma, and inequality, especially in health care. This study aimed to characterize the experience of TGD people and partners of TGD people with regard to fertility treatment. Methods All TGD patients presenting to a single academic center between 2013 and 2021 were included. Baseline demographics collected included patient age, body mass index, anti-Mullerian hormone, basal antral follicle count, history of gender-affirming surgery, and/or gender-affirming hormone therapy. Outcomes included total patients who progressed to treatment, cycle type(s), and clinical outcomes. Results In total, 82 patients who identified as TGD or had a partner who identified as TGD presented to care seeking fertility treatment. Of the 141 planned cycles, 106 (75.2%) progressed to treatment. Of the 15 in vitro fertilization (IVF) and co-IVF cycles, 12 achieved live birth. Of the 76 intrauterine inseminations 7 patients were discharged with ongoing pregnancies and one achieved live birth. Conclusion These findings reaffirm that TGD individuals utilize the entire array of fertility services. With recent advances in access to care and modern medicine, assisted reproductive technology treatment has the power to support TGD patients in building contemporary family structures.
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Affiliation(s)
- Atoosa Ghofranian
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Devora Aharon
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Reproductive Medicine Associates of New York, New York, New York, USA
| | - Jenna Friedenthal
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Reproductive Medicine Associates of New York, New York, New York, USA
| | - William J. Hanley
- Reproductive Medicine Associates of New York, New York, New York, USA
| | - Joseph A. Lee
- Reproductive Medicine Associates of New York, New York, New York, USA
| | - Margaret Daneyko
- Reproductive Medicine Associates of New York, New York, New York, USA
| | - Zoe Rodriguez
- Mount Sinai Center for Transgender Medicine and Surgery, New York, New York, USA
| | - Joshua D. Safer
- Mount Sinai Center for Transgender Medicine and Surgery, New York, New York, USA
| | - Alan B. Copperman
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Reproductive Medicine Associates of New York, New York, New York, USA
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9
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Komorowski AS, Fisher AR, Jungheim ES, Lewis CS, Omurtag KR. Fertility preservation discussions, referral and follow-up in male-to-female and female-to-male adolescent transgender patients. HUM FERTIL 2023; 26:903-907. [PMID: 34915792 DOI: 10.1080/14647273.2021.2015804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 09/26/2021] [Indexed: 10/19/2022]
Abstract
The number of patients seeking transgender healthcare is growing, and there is a potential impact of gender-affirming therapies on fertility. The use of fertility preservation (FP), particularly among transgender adolescents, has been limited. We aimed to examine differences in FP counselling, referral and utilisation between male-to-female (MtF) and female-to-male (FtM) transgender adolescents. A retrospective review of the medical records of patients ages 12-17 seen at an academic medical centre between 2012 and 2017 with a diagnosis of gender dysphoria was conducted. A total of 22 MtF and 45 FtM adolescents were included. The counselling on the potential fertility impact of gender-affirming therapy was documented in 55%, and of those counselled, 73% were counselled before receiving medication. There was no significant difference between the timing of counselling for MtF versus FtM adolescents. Of patients with documented reproductive wishes, 77% reported either desire for adopted children or no desire for biological children. Among patients offered FP referral, 2 (22.2%) MtF and 3 (12.5%) FtM patients accepted; both MtF patients cryopreserved sperm. While most adolescents were counselled on the fertility impact of gender-affirming therapy, there is room for improvement as 45% of patients had no documented counselling. The rate of transgender adolescents pursuing FP consultation and gamete cryopreservation was low, consistent with prior studies in this population.
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Affiliation(s)
- Allison S Komorowski
- Department of Obstetrics & Gynecology, Washington University School of Medicine, St. Louis, USA
| | - Andrew R Fisher
- Department of Obstetrics & Gynecology, The University of Chicago Medicine, Chicago, USA
| | - Emily S Jungheim
- Department of Obstetrics & Gynecology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Christopher S Lewis
- Division of Pediatric Endocrinology & Metabolism, Washington University School of Medicine, St. Louis, USA
| | - Kenan R Omurtag
- Department of Obstetrics & Gynecology, Washington University School of Medicine, St. Louis, USA
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10
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Craig Sineath R, Guerre M, Martin L, Chouhan JD. Interest In and Prior Receipt of Counseling on Fertility Preservation in Transgender Patients Presenting for Gender-affirming Orchiectomy. Urology 2023; 182:101-105. [PMID: 37517680 DOI: 10.1016/j.urology.2023.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/11/2023] [Accepted: 07/17/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE To describe the characteristics of patients presenting for gender-affirming bilateral simple orchiectomy including interest in and prior education on reproductive options prior to gonad removal. METHODS A retrospective chart review evaluated patients seeking gender-affirming bilateral orchiectomy. Data collected included age, family history, history of fertility preservation education prior to gender-affirming hormone therapy initiation, prior fertility preservation, interest in fertility preservation, and postorchiectomy surgical pathology results where applicable. RESULTS The cohort included 78 patients. 22% (n = 17) indicated reproductive options were not discussed prior to surgical consultation. 85% (n = 66) were not interested in fertility preservation. Reasons included not having an interest in biological children (74%), not wanting to delay transition (47%), and cost (36%). Patients who were married or in long-term relationships had a higher interest in fertility preservation compared to patients who were not in long-term relationships. 40% of patients with pathology data available had at least some level of spermatogenesis present in their testicular tissue. CONCLUSION Fertility preservation counseling prior to surgical referral was lower than expected. This lack of counseling could result in patients not wanting to sperm bank prior to orchiectomy as it could delay their surgical care. Increased adherence to the WPATH guidelines may improve fertility preservation interest. Our data shows a low utilization and interest in sperm preservation for transwomen and nonbinary patients seeking bilateral simple orchiectomy at our institution. Improving counseling regarding fertility preservation options earlier in transition could improve utilization of sperm cryopreservation.
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Affiliation(s)
- R Craig Sineath
- Department of Urology, Oregon Health & Science University, Portland, OR
| | - Megan Guerre
- Department of Urology, Oregon Health & Science University, Portland, OR
| | - Leigh Martin
- School of Medicine, Oregon Health & Science University, Portland, OR
| | - Jyoti D Chouhan
- Department of Urology, Oregon Health & Science University, Portland, OR.
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11
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Vrouenraets LJJJ, de Vries ALC, Arnoldussen M, Hannema SE, Lindauer RJL, de Vries MC, Hein IM. Medical decision-making competence regarding puberty suppression: perceptions of transgender adolescents, their parents and clinicians. Eur Child Adolesc Psychiatry 2023; 32:2343-2361. [PMID: 36115898 PMCID: PMC10576681 DOI: 10.1007/s00787-022-02076-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 08/31/2022] [Indexed: 11/30/2022]
Abstract
According to international transgender care guidelines, transgender adolescents should have medical decision-making competence (MDC) to start puberty suppression (PS) and halt endogenous pubertal development. However, MDC is a debated concept in adolescent transgender care and little is known about the transgender adolescents', their parents', and clinicians' perspectives on this. Increasing our understanding of these perspectives can improve transgender adolescent care. A qualitative interview study with adolescents attending two Dutch gender identity clinics (eight transgender adolescents who proceeded to gender-affirming hormones after PS, and six adolescents who discontinued PS) and 12 of their parents, and focus groups with ten clinicians was conducted. From thematic analysis, three themes emerged regarding transgender adolescents' MDC to start PS: (1) challenges when assessing MDC, (2) aspects that are considered when assessing MDC, and (3) MDC's relevance. The four criteria one needs to fulfill to have MDC-understanding, appreciating, reasoning, communicating a choice-were all, to a greater or lesser extent, mentioned by most participants, just as MDC being relative to a specific decision and context. Interestingly, most adolescents, parents and clinicians find understanding and appreciating PS and its consequences important for MDC. Nevertheless, most state that the adolescents did not fully understand and appreciate PS and its consequences, but were nonetheless able to decide about PS. Parents' support of their child was considered essential in the decision-making process. Clinicians find MDC difficult to assess and put into practice in a uniform way. Dissemination of knowledge about MDC to start PS would help to adequately support adolescents, parents and clinicians in the decision-making process.
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Affiliation(s)
- Lieke Josephina Jeanne Johanna Vrouenraets
- Department of Medical Psychology, Willem Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands.
- Department of Medical Ethics and Health Law, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - Annelou L C de Vries
- Department of Child and Adolescent Psychiatry, Emma Children's Hospital, Amsterdam University Medical Centers, Location VUmc, Amsterdam, The Netherlands
- Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Location VUmc, Amsterdam, The Netherlands
| | - Marijn Arnoldussen
- Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Location VUmc, Amsterdam, The Netherlands
| | - Sabine E Hannema
- Department of Paediatric Endocrinology, Amsterdam University Medical Centers, Location VUmc, Amsterdam, The Netherlands
- Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Ramón J L Lindauer
- Department of Child and Adolescent Psychiatry, Amsterdam University Medical Centers, Location AMC, University of Amsterdam and Levvel, Amsterdam, The Netherlands
| | - Martine C de Vries
- Department of Medical Ethics and Health Law, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
- Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Irma M Hein
- Department of Child and Adolescent Psychiatry, Amsterdam University Medical Centers, Location AMC, University of Amsterdam and Levvel, Amsterdam, The Netherlands
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12
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Barrero JA, Mockus I. Preservation of Fertility in Transgender Men on Long-Term Testosterone Therapy: A Systematic Review of Oocyte Retrieval Outcomes During and After Exogenous Androgen Exposure. Transgend Health 2023; 8:408-419. [PMID: 37810944 PMCID: PMC10551752 DOI: 10.1089/trgh.2022.0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Testosterone therapy prompts the development of male secondary sexual characteristics coupled with numerous physiological changes; however, the effect of prolonged androgen exposure on transgender men's fertility remains to be fully elucidated. Multiple clinical consensuses advise assisted reproduction before hormone treatment and state that fertility preservation following androgen therapy entails the suspension of testosterone administration. Although the desire for reproduction among transgender men is prevalent, the discontinuation of gender-affirming hormone therapy poses a major challenge due to the anxiety, unease, and gender dysphoria that follow androgen withdrawal. The present investigation aimed to explore the feasibility and outcomes of oocyte retrieval in adult transgender men undergoing testosterone administration before or during fertility preservation. Seven case reports, four cohort studies, and two cross-sectional studies were identified following a systematic literature search on the PubMed/Ovid MEDLINE, Scopus, and ScienceDirect databases. The findings gathered in this review disclose the viability of oocyte retrieval after prolonged androgen exposure and suggest the absence of a direct relationship between the duration of testosterone suspension and fertility preservation outcomes. Although the reports are limited, recent evidence shows that continuous testosterone administration and the use of aromatase inhibitors during ovarian stimulation could potentially reduce the distressing effects of hormonal ovulation induction. New approaches to fertility preservation in transgender men must be further explored to ensure interventions aligned both with the reproductive desire and avoidance of gender dysphoria exacerbation that follow hormone therapy suspension.
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Affiliation(s)
- Jorge A. Barrero
- Lipids and Diabetes Division, Department of Physiological Sciences, Faculty of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Ismena Mockus
- Lipids and Diabetes Division, Department of Physiological Sciences, Faculty of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia
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13
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Godiwala P, Uliasz TF, Lowther KM, Kaback D, Mehlmann LM. Puberty Suppression Followed by Testosterone Therapy Does Not Impair Reproductive Potential in Female Mice. Endocrinology 2023; 164:bqad145. [PMID: 37768169 DOI: 10.1210/endocr/bqad145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 08/11/2023] [Accepted: 09/22/2023] [Indexed: 09/29/2023]
Abstract
More adolescents are coming out as transgender each year and are put on puberty blockers to suppress natal puberty, which is then followed by cross-hormone treatment to achieve puberty of the desired gender. Studies to examine the effects of puberty suppression and virilizing therapy on future reproductive potential among transgender males are lacking. This study used a translational murine in vitro fertilization model to examine the effects of female puberty suppression with depot leuprolide acetate (LA), followed by virilizing therapy with testosterone cypionate (T), on embryologic and pregnancy outcomes. LA effectively inhibited puberty when mice were treated beginning at 3 weeks of age. LA treatment was associated with higher mouse weight but lower ovarian weight. LA-treated mice ovulated developmentally competent eggs in response to gonadotropin administration, albeit at a higher dose than controls. Ovaries from mice treated with LA and T produced oocytes that had morphologically normal meiotic spindles after in vitro maturation and responded to gonadotropin stimulation. Eggs from mice treated with LA and T were fertilizable and produced developmentally competent embryos that led to births of fertile pups. These results suggest that fertility may not be impaired after puberty suppression and cross-hormone therapy for transgender males.
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Affiliation(s)
- Prachi Godiwala
- Department of Cell Biology, UConn Health, Farmington, CT 06030, USA
- Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, UConn Health, Farmington, CT 06030, USA
| | - Tracy F Uliasz
- Department of Cell Biology, UConn Health, Farmington, CT 06030, USA
| | - Katie M Lowther
- Department of Cell Biology, UConn Health, Farmington, CT 06030, USA
| | - Deborah Kaback
- Department of Cell Biology, UConn Health, Farmington, CT 06030, USA
| | - Lisa M Mehlmann
- Department of Cell Biology, UConn Health, Farmington, CT 06030, USA
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14
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Halloran J, Smidt AM, Morrison A, Cron J, Kallen AN, Olezeski CL. Reproductive and Fertility Knowledge and Attitudes Among Transgender and Gender-Expansive Youth: A Replication and Extension. Transgend Health 2023; 8:328-336. [PMID: 37525841 PMCID: PMC10387155 DOI: 10.1089/trgh.2021.0080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose This study sought to replicate and expand a previous pilot investigation of reproductive knowledge, attitudes toward fertility and parenthood, and sources of information on these topics among transgender and gender-expansive (TGE) youth. Methods The Yale Pediatric Gender Program (YPGP) Reproductive Knowledge and Experiences Survey (YPGP-RKES) was administered to 70 TGE adolescents receiving care at an interdisciplinary clinic providing gender-affirming health care at an academic medical center. Data gathered included sources of information on reproduction and fertility, concerns about future parenthood and reproduction, and interest in different types of parenthood. Results Over a third (39.1%) of participants reported it was important to them to have a child one day, while only a small proportion (23.2%) reported an interest in biological parenthood. A plurality of participants (37.3%) reported at least one concern about future fertility. The number of reproductive concerns did not differ by age or treatment (puberty blockers or gender-affirming hormones vs. no treatment) status. With respect to needs for more information and sources of information, most (56.5%) participants received information about fertility issues before this study, with the most cited source of information being online research. Conclusions The current study replicated and extended previous findings on the reproductive attitudes and knowledge of TGE adolescents. Understanding the informational needs and priorities of adolescent TGE patients presenting for medical treatment will allow providers to give more robust patient education. This will, in turn, facilitate patients' ability to provide fully informed consent for treatment that aligns with their fertility and reproductive priorities and goals.
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Affiliation(s)
- Justin Halloran
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Alec M. Smidt
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Aimee Morrison
- Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Julia Cron
- Department of Obstetrics, Gynecology, & Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
| | - Amanda N. Kallen
- Department of Obstetrics, Gynecology, & Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
| | - Christy L. Olezeski
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
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15
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Wright S. Biohacking Queer and Trans Fertility: Using Social Media to Form Communities of Knowledge. THE JOURNAL OF MEDICAL HUMANITIES 2023; 44:187-205. [PMID: 36698040 DOI: 10.1007/s10912-022-09776-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/12/2022] [Indexed: 05/07/2023]
Abstract
Biohacking involves individuals determining, developing, and directing relevant activities to meet their personal biological goals. Biohacking fertility is a resilient method that trans and genderqueer people use to meet their reproductive and family-planning needs in the face of historic medical marginalization and oppression. In this study, nine participants were recruited from three different Facebook groups specific to queer and trans fertility, family planning, pregnancy, and parenting. Each participant's posts and comments to their respective Facebook group(s) were analyzed, followed by interviews with participants. A total of 1,155 Facebook posts were collected. Biohacking activity-understood as a web of activity including gathering information, applying knowledge to personal circumstances, and sharing personal experiences and knowledge-was found in each of the three groups. Participants identified these online groups as safer spaces to learn more about their own fertility and find community. Participants were active in these groups to biohack their fertility at home and to become empowered at the doctor's office or fertility clinic, ultimately achieving agency in their fertility and family planning.
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Affiliation(s)
- Shain Wright
- Washington State University, Cultural Studies and Social Thought in Education, Pullman, WA, USA.
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16
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Sciorio R, Aiello R, Janssens R. Considerations on staffing levels for a modern assisted reproductive laboratory. JBRA Assist Reprod 2023; 27:120-130. [PMID: 36515254 PMCID: PMC10065777 DOI: 10.5935/1518-0557.20220048] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 08/23/2022] [Indexed: 12/12/2022] Open
Abstract
The duties recently performed in the embryology laboratory have deeply increased compared to those realized a couple of decades ago. Currently, procedures include conventional in vitro fertilization (IVF) and ICSI techniques, or processing of surgically retrieved sperm, embryo culture and time-lapse monitoring, blastocyst culture, as well as trophectoderm biopsy for preimplantation genetic testing and cryopreservation. These techniques require not only time, but also high knowledge level and acutely concentration by the embryologist team. The existing data indicate that an IVF laboratory need to have adequate staffing levels to perform the required daily duties, and to work in optimal conditions that are critical to assure a high quality service, as well as avoiding incidents and to provide the best outcomes. As a result, IVF clinics have invested in human resources, but there is still a large discrepancy between IVF centres on the number of embryologists employed. Currently there is no golden standard on the human resource requirements for assisted reproductive technology procedures; therefore, in this review paper we aim to provide arguments to take into account to determine the embryology staffing requirements in an embryology laboratory to assure optimal safety and efficiency of operations.
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Affiliation(s)
- Romualdo Sciorio
- Edinburgh Assisted Conception Programme, EFREC, Royal Infirmary of
Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh, Scotland, EH16
4SA, UK
| | - Raffaele Aiello
- OMNIA Lab S.C.a.R.L, Via Cesare Rosaroll 24, 80139 Naples, Italy
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17
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Albar M, Koziarz A, McMahon E, Chan C, Liu K. Timing of testosterone discontinuation and assisted reproductive technology outcomes in transgender patients: a cohort study. F S Rep 2023; 4:55-60. [PMID: 36959967 PMCID: PMC10028470 DOI: 10.1016/j.xfre.2023.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 01/12/2023] [Accepted: 01/17/2023] [Indexed: 01/22/2023] Open
Abstract
Objective To determine if there is an association between the timing of testosterone discontinuation and assisted reproductive technology (ART) outcomes. Design Retrospectivse cohort study. Setting Single academic center. Patients We included consecutive transgender patients seeking fertility preservation between October 2019 and April 2021. Patients who identified as transgender on androgens for >1 month on presentation were included. Interventions None. Main outcome measures A linear regression model was used to evaluate the effect of testosterone discontinuation duration on the number of mature oocytes retrieved. Results Eighteen patients (mean age 27.7 [SD 5.2] years, mean body mass index 27.3 [SD 4.6] kg/m2, mean antimüllerian hormone 27.2 [SD 11.8], median antral follicle count 20 [interquartile range (IQR) 14-32]) were included in the analysis. No patient underwent transition-related surgery (eg, oophorectomy, hysterectomy). None of the patients were previously pregnant. Mean time o,n testosterone was 44 (SD 29.6) months. The median time off testosterone until the start of ovarian stimulation was 7.7 weeks (IQR 4.3-20.7). All patients underwent oocyte cryopreservation except one who had embryo cryopreservation. The median total number of oocytes was 11 (IQR 7-14). The median number of mature oocytes was 7.5 (IQR 5-12) oocytes. The univariate regression model evaluating the duration of time off testosterone before ART demonstrated no significant association with the outcome of mature oocytes (regression coefficient, 0.19; 95% confidence interval, -0.13 to 0.50). Conclusion In a retrospective analysis of transgender patients recently on testosterone undergoing ART, no association was detected between the timing of testosterone cessation and the number of mature oocytes.
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Affiliation(s)
- Mohammad Albar
- Department of Obstetrics and Gynaecology, University of King Abdulaziz, Jeddah, Saudi Arabia
| | - Alex Koziarz
- Department of Radiology, McMaster University, Hamilton, Ontario, Canada
| | - Eileen McMahon
- Hannam Fertility Centre, Toronto, Ontario, Canada
- Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada
| | - Crystal Chan
- Markham Fertility Centre, Toronto, Ontario, Canada
| | - Kimberly Liu
- Mount Sinai Fertility, Toronto, Ontario, Canada
- Reprint requests: Kimberly Liu, M.D., M.S.L., Division of Reproductive Endocrinology and Infertility, Mount Sinai Fertility, University of Toronto, 250 Dundas Street West, Suite 700, Ontario, Canada.
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18
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Moravek MB, Dixon M, Pena SM, Obedin-Maliver J. Management of testosterone around ovarian stimulation in transmasculine patients: challenging common practices to meet patient needs-2 case reports. Hum Reprod 2023; 38:482-488. [PMID: 36644915 PMCID: PMC9977120 DOI: 10.1093/humrep/dead003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 12/05/2022] [Indexed: 01/17/2023] Open
Abstract
Approximately 50% of transmasculine people use testosterone for gender affirmation, yet very little is known about the effects of testosterone on future reproductive capacity. Moreover, there are no data to guide fertility specialists on how to manage testosterone leading up to or during ovarian stimulation. Most clinics require cessation of testosterone prior to ovarian stimulation in this setting of no data; however, the current literature does suggest a potential increase in dysphoria with cessation of testosterone and during stimulation. This divergence begs the question of whether clinicians may be doing more harm than good by enacting this requirement. Here, we present two cases of transmasculine individuals who were on testosterone prior to stimulation and maintained their testosterone dosage throughout stimulation as proof of concept, followed by a discussion of current clinical practice and providing some rationale to support continuation of testosterone throughout stimulation.
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Affiliation(s)
- Molly B Moravek
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Marjorie Dixon
- Anova Fertility and Reproductive Health, North York, Ontario, Canada
| | - Samantha M Pena
- Anova Fertility and Reproductive Health, North York, Ontario, Canada
| | - Juno Obedin-Maliver
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, CA, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, CA, USA
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19
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Stolk THR, Asseler JD, Huirne JAF, van den Boogaard E, van Mello NM. Desire for children and fertility preservation in transgender and gender-diverse people: A systematic review. Best Pract Res Clin Obstet Gynaecol 2023; 87:102312. [PMID: 36806443 DOI: 10.1016/j.bpobgyn.2023.102312] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/30/2022] [Accepted: 01/13/2023] [Indexed: 01/22/2023]
Abstract
The decision to pursue one's desire for children is a basic human right. For transgender and gender-diverse (TGD) people, gender-affirming care may alter the possibilities to fulfill one's desire for children due to the impact of this treatment on their reproductive organs. We systematically included 76 studies of varying quality describing the desire for children and parenthood; fertility counseling and utilization; and fertility preservation options and outcomes in TGD people. The majority of TGD people expressed a desire for children. Fertility preservation utilization rates were low as there are many barriers to pursue fertility preservation. The most utilized fertility preservation strategies include oocyte vitrification and sperm banking through masturbation. Oocyte vitrification showed successful outcomes, even after testosterone cessation. Sperm analyses when banking sperm showed a lower quality compared to cis male samples even prior to gender-affirming hormone treatment and an uncertain recovery of spermatogenesis after discontinuing treatment.
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Affiliation(s)
- T H R Stolk
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Center of Expertise on Gender Dysphoria, De Boelelaan 1117, Amsterdam University Medical Centers, the Netherlands; Amsterdam UMC, Department of Obstetrics & Gynaecology, Amsterdam, the Netherlands; Amsterdam Reproduction and Development, Amsterdam, the Netherlands.
| | - J D Asseler
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Center of Expertise on Gender Dysphoria, De Boelelaan 1117, Amsterdam University Medical Centers, the Netherlands; Amsterdam UMC, Department of Obstetrics & Gynaecology, Amsterdam, the Netherlands; Amsterdam Reproduction and Development, Amsterdam, the Netherlands.
| | - J A F Huirne
- Amsterdam UMC, Department of Obstetrics & Gynaecology, Amsterdam, the Netherlands; Amsterdam Reproduction and Development, Amsterdam, the Netherlands.
| | - E van den Boogaard
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Center of Expertise on Gender Dysphoria, De Boelelaan 1117, Amsterdam University Medical Centers, the Netherlands; Amsterdam UMC, Department of Obstetrics & Gynaecology, Amsterdam, the Netherlands; Amsterdam Reproduction and Development, Amsterdam, the Netherlands.
| | - N M van Mello
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Center of Expertise on Gender Dysphoria, De Boelelaan 1117, Amsterdam University Medical Centers, the Netherlands; Amsterdam UMC, Department of Obstetrics & Gynaecology, Amsterdam, the Netherlands; Amsterdam Reproduction and Development, Amsterdam, the Netherlands.
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20
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van Amesfoort JE, van Rooij FB, Painter RC, Valkenburg-van den Berg AW, Kreukels BPC, Steensma TD, Huirne JAF, de Groot CJM, Van Mello NM. The barriers and needs of transgender men in pregnancy and childbirth: A qualitative interview study. Midwifery 2023; 120:103620. [PMID: 36893550 DOI: 10.1016/j.midw.2023.103620] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/30/2022] [Accepted: 01/24/2023] [Indexed: 02/18/2023]
Abstract
OBJECTIVE Transgender and gender diverse individuals are individuals whose gender identity differs from their sex assigned at birth. The discordance between gender identity and sex assignment may cause significant psychological distress: gender dysphoria. Transgender individuals may choose to undergo gender-affirming hormone treatment or surgery, but some decide to (temporarily) refrain from surgery and gender affirming hormone treatment and hence retain the possibility to become pregnant. Pregnancy may enhance feelings of gender dysphoria and isolation. To improve perinatal care for transgender individuals and their health care providers, we conducted interviews to explore the needs and barriers of transgender men in family planning, pregnancy, childbirth, puerperium and perinatal care. DESIGN In this qualitative study five in-depth semi-structured interviews were conducted with Dutch transgender men who had given birth while identifying on the transmasculine spectrum. The interviews were conducted online through a video remote-conferencing software program (n=4) or live (n=1). Interviews were transcribed verbatim. An inductive approach was used to find patterns and collect data from the participants' narratives and constant comparative method was adapted in analysing the interviews. MEASUREMENTS AND FINDINGS The experiences of transgender men regarding the preconception period, pregnancy and puerperium and with perinatal care varied widely. Though all participants expressed overall positive experiences, their narratives emphasized they had to overcome substantial hurdles pursuing pregnancy. For instance the necessity to prioritise becoming pregnant over gender transitioning, lack of support by healthcare providers and increased gender dysphoria and isolation during pregnancy KEY CONCLUSIONS: Since pregnancy in transgender men enhances feelings of gender dysphoria, transgender men comprise a vulnerable group in perinatal care. Health care providers are perceived as feeling unaccustomed for the care of transgender patients, as they are perceived to often lack the right tools and knowledge to provide adequate care. Our findings help strengthen the foundation of insight in the needs and hurdles of transgender men pursuing pregnancy and therefore may guide health care providers to provide equitable perinatal care, and emphasize the necessity of patient-centred gender-inclusive perinatal care. A guideline including the option for consultation of an expertise center is advised to facilitate patient-centered gender-inclusive perinatal care.
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Affiliation(s)
- J E van Amesfoort
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - F B van Rooij
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, the Netherlands
| | - R C Painter
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - A W Valkenburg-van den Berg
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - B P C Kreukels
- Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands; Department of Medical Psychology, Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands
| | - T D Steensma
- Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands; Department of Medical Psychology, Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands
| | - J A F Huirne
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, Reproduction and Development Research Institute, Amsterdam, the Netherlands; Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands
| | - C J M de Groot
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - N M Van Mello
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, Reproduction and Development Research Institute, Amsterdam, the Netherlands; Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands.
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21
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Mendes N, Woestlandt L, Moreau C, Eustache F, Condat A. [Ethical implications of supporting trans or questioning children and adolescents: Articulation with reproductive health]. Med Sci (Paris) 2023; 39:44-48. [PMID: 36692318 DOI: 10.1051/medsci/2022197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Supporting children and adolescents who are trans or who are questioning cannot be done without an ethical reflection on one's own practice as a health professional. It is important to consider the young person as a whole, including reproductive health issues. This article proposes, through the principles of Beauchamps and Childress, an ethical reflection on the issues of beneficence - not maleficence, and of autonomy and justice for adolescents, young adults, and future trans or questioning parents. For adolescents, concerning the possibilities of medical treatment of gender affirmation, we need to propose information in terms of impact on fertility and, if necessary, proposals for the possibilities of preserving their reproductive capacities. These issues require to question the state of scientific knowledge in terms of parenthood of trans people and questioning. We propose here a state of knowledge of these realities, put in perspectives of the axes of ethical reflections inherent to guidance. In fine, it appears that the major ethical stake concerns the child to be born. Finally, it is necessary to consider the quality of life of the future parents and the impact of their medical follow-up.
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Affiliation(s)
- Nicolas Mendes
- Service de psychiatrie de l'enfant et de l'adolescent, Groupe hospitalier Pitié-Salpêtrière, AP-HP. Sorbonne université, 47 bd de l'Hôpital, 75013, Paris, France - Plateforme Trajectoires jeunes trans d'Île-de-France, enfants, adolescents et jeunes adultes - Équipe d'accueil CLIPSYD (clinique psychanalyse développement) EA 4430, Connaissance, langage, modélisation (ED 139), université Paris Ouest-Nanterre-La Défense, 92000 Nanterre, France - Service d'histologieembryologie, cytogénétique, biologie de la reproduction/CECOS (centre d'étude et de conservation du sperme), Hôpitaux universitaires Paris Seine-Saint-Denis, site Jean Verdier, 93143 Bondy Cedex, France
| | - Laure Woestlandt
- Service de psychiatrie de l'enfant et de l'adolescent, Groupe hospitalier Pitié-Salpêtrière, AP-HP. Sorbonne université, 47 bd de l'Hôpital, 75013, Paris, France - Plateforme Trajectoires jeunes trans d'Île-de-France, enfants, adolescents et jeunes adultes
| | - Clément Moreau
- Plateforme Trajectoires jeunes trans d'Île-de-France, enfants, adolescents et jeunes adultes - Association Espace santé trans, 88 rue Philippe de Girard, 75018 Paris, France
| | - Florence Eustache
- Plateforme Trajectoires jeunes trans d'Île-de-France, enfants, adolescents et jeunes adultes - Service d'histologieembryologie, cytogénétique, biologie de la reproduction/CECOS (centre d'étude et de conservation du sperme), Hôpitaux universitaires Paris Seine-Saint-Denis, site Jean Verdier, 93143 Bondy Cedex, France
| | - Agnès Condat
- Service de psychiatrie de l'enfant et de l'adolescent, Groupe hospitalier Pitié-Salpêtrière, AP-HP. Sorbonne université, 47 bd de l'Hôpital, 75013, Paris, France - Plateforme Trajectoires jeunes trans d'Île-de-France, enfants, adolescents et jeunes adultes
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22
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Grateau S, Dupont C, Rivet-Danon D, Béranger A, Johnson N, Mathieu d'Argent E, Chabbert-Buffet N, Sermondade N. [Fertility preservation for transmen]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2022; 50:797-804. [PMID: 36183988 DOI: 10.1016/j.gofs.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 08/23/2022] [Accepted: 09/20/2022] [Indexed: 06/16/2023]
Abstract
The evolution of medical techniques as well as legislative changes currently allow to propose fertility preservation strategies in the context of transidentity. During "female to male" transition, androgen therapy has an impact on gonadal function since it usually induces a blockage of ovulation with amenorrhea. Although this effect is reversible when treatment is stopped, the possible long-term effects of testosterone treatment on future fertility or health of future children are poorly known. In addition, transitional surgeries definitely compromise fecundity when they include bilateral ovariectomy and/or hysterectomy. Yet, although long ignored or poorly expressed, the desire for parenthood is a reality in transgender men. Fertility preservation options in FtM transition rely on oocyte or ovarian tissue cryopreservation. The purpose of this review is to provide an overview of the literature regarding fertility preservation in transgender men. Although series remain limited, the increase in the number of recently published articles reflects the interest in improving the management of fertility issues in transgender men.
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Affiliation(s)
- S Grateau
- Service de biologie de la reproduction - CECOS, Sorbonne université, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - C Dupont
- Service de biologie de la reproduction - CECOS, Sorbonne université, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - D Rivet-Danon
- Service de biologie de la reproduction - CECOS, Sorbonne université, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - A Béranger
- Service de biologie de la reproduction - CECOS, Sorbonne université, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - N Johnson
- Service de gynécologie-obstétrique-médecine de la reproduction, Sorbonne université, hôpital Tenon, AP-HP, Paris, France
| | - E Mathieu d'Argent
- Service de gynécologie-obstétrique-médecine de la reproduction, Sorbonne université, hôpital Tenon, AP-HP, Paris, France
| | - N Chabbert-Buffet
- Service de gynécologie-obstétrique-médecine de la reproduction, Sorbonne université, hôpital Tenon, AP-HP, Paris, France
| | - N Sermondade
- Service de biologie de la reproduction - CECOS, Sorbonne université, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France.
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Puy V, Magnan F, Lousqui J, Boumerdassi Y, Bennani Smires B, Mendes N, Eustache F. Préservation de la fertilité chez les personnes transgenres. Med Sci (Paris) 2022; 38:926-933. [DOI: 10.1051/medsci/2022154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
La majorité des personnes transgenres envisage de fonder une famille, mais leur fertilité peut être altérée par l’affirmation du genre. L’hormonothérapie peut affecter durablement la production de gamètes, notamment chez les femmes trans. La chirurgie de réassignation sexuelle entraîne une stérilité définitive. En France, des réseaux de professionnels de santé se sont organisés. Ils recommandent l’accès à la préservation de la fertilité dans le cadre de la transidentité. Cependant, le recueil de gamètes reste souvent difficile en raison de l’incongruence hormonale pour les femmes trans, ou du caractère invasif de la procédure pour les hommes trans. De futures études permettront de statuer sur l’utilisation des gamètes autoconservés.
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Fertility Preservation and Reproductive Potential in Transgender and Gender Fluid Population. Biomedicines 2022; 10:biomedicines10092279. [PMID: 36140377 PMCID: PMC9496568 DOI: 10.3390/biomedicines10092279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/09/2022] [Accepted: 09/11/2022] [Indexed: 11/16/2022] Open
Abstract
The gender diverse and transgender community is a minor patient group that is encountered with increasing frequency in the clinical setting, attributed to the improved awareness and access to medical facilities. Partial impairment to permanent elimination of fertility potential and outcomes depending on the treatment modality usually is a result of gender-affirming therapy, which includes both hormone therapy and surgical intervention. Although seldom conducted in the clinical field, transgender patients should be counseled on their fertility preservation options prior to medical and surgical gender transition. There is relatively limited data and clinical information regarding fertility preservation for transgender individuals. Current treatment regimens are based on protocols from fertility preservation after oncological treatments. Major barriers for the transgender population exist due to the lack of information provided and clinical narrative that is not familiar to the physician or health care provider, although there are various options for fertility preservation. A deeper understanding of this clinical agenda and the mandatory processes will ultimately result in a much more comprehensive and specific care for transgender individuals who are in great need for fertility counseling or treatment options that concern fertility preservation. In this review, current clinical approaches will be summarized and fertility preservation options along with ongoing and future clinical trials in fertility preservation for transgender individuals will be thoroughly reviewed.
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Coleman E, Radix AE, Bouman WP, Brown GR, de Vries ALC, Deutsch MB, Ettner R, Fraser L, Goodman M, Green J, Hancock AB, Johnson TW, Karasic DH, Knudson GA, Leibowitz SF, Meyer-Bahlburg HFL, Monstrey SJ, Motmans J, Nahata L, Nieder TO, Reisner SL, Richards C, Schechter LS, Tangpricha V, Tishelman AC, Van Trotsenburg MAA, Winter S, Ducheny K, Adams NJ, Adrián TM, Allen LR, Azul D, Bagga H, Başar K, Bathory DS, Belinky JJ, Berg DR, Berli JU, Bluebond-Langner RO, Bouman MB, Bowers ML, Brassard PJ, Byrne J, Capitán L, Cargill CJ, Carswell JM, Chang SC, Chelvakumar G, Corneil T, Dalke KB, De Cuypere G, de Vries E, Den Heijer M, Devor AH, Dhejne C, D'Marco A, Edmiston EK, Edwards-Leeper L, Ehrbar R, Ehrensaft D, Eisfeld J, Elaut E, Erickson-Schroth L, Feldman JL, Fisher AD, Garcia MM, Gijs L, Green SE, Hall BP, Hardy TLD, Irwig MS, Jacobs LA, Janssen AC, Johnson K, Klink DT, Kreukels BPC, Kuper LE, Kvach EJ, Malouf MA, Massey R, Mazur T, McLachlan C, Morrison SD, Mosser SW, Neira PM, Nygren U, Oates JM, Obedin-Maliver J, Pagkalos G, Patton J, Phanuphak N, Rachlin K, Reed T, Rider GN, Ristori J, Robbins-Cherry S, Roberts SA, Rodriguez-Wallberg KA, Rosenthal SM, Sabir K, Safer JD, Scheim AI, Seal LJ, Sehoole TJ, Spencer K, St Amand C, Steensma TD, Strang JF, Taylor GB, Tilleman K, T'Sjoen GG, Vala LN, Van Mello NM, Veale JF, Vencill JA, Vincent B, Wesp LM, West MA, Arcelus J. Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2022; 23:S1-S259. [PMID: 36238954 PMCID: PMC9553112 DOI: 10.1080/26895269.2022.2100644] [Citation(s) in RCA: 525] [Impact Index Per Article: 262.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Background: Transgender healthcare is a rapidly evolving interdisciplinary field. In the last decade, there has been an unprecedented increase in the number and visibility of transgender and gender diverse (TGD) people seeking support and gender-affirming medical treatment in parallel with a significant rise in the scientific literature in this area. The World Professional Association for Transgender Health (WPATH) is an international, multidisciplinary, professional association whose mission is to promote evidence-based care, education, research, public policy, and respect in transgender health. One of the main functions of WPATH is to promote the highest standards of health care for TGD people through the Standards of Care (SOC). The SOC was initially developed in 1979 and the last version (SOC-7) was published in 2012. In view of the increasing scientific evidence, WPATH commissioned a new version of the Standards of Care, the SOC-8. Aim: The overall goal of SOC-8 is to provide health care professionals (HCPs) with clinical guidance to assist TGD people in accessing safe and effective pathways to achieving lasting personal comfort with their gendered selves with the aim of optimizing their overall physical health, psychological well-being, and self-fulfillment. Methods: The SOC-8 is based on the best available science and expert professional consensus in transgender health. International professionals and stakeholders were selected to serve on the SOC-8 committee. Recommendation statements were developed based on data derived from independent systematic literature reviews, where available, background reviews and expert opinions. Grading of recommendations was based on the available evidence supporting interventions, a discussion of risks and harms, as well as the feasibility and acceptability within different contexts and country settings. Results: A total of 18 chapters were developed as part of the SOC-8. They contain recommendations for health care professionals who provide care and treatment for TGD people. Each of the recommendations is followed by explanatory text with relevant references. General areas related to transgender health are covered in the chapters Terminology, Global Applicability, Population Estimates, and Education. The chapters developed for the diverse population of TGD people include Assessment of Adults, Adolescents, Children, Nonbinary, Eunuchs, and Intersex Individuals, and people living in Institutional Environments. Finally, the chapters related to gender-affirming treatment are Hormone Therapy, Surgery and Postoperative Care, Voice and Communication, Primary Care, Reproductive Health, Sexual Health, and Mental Health. Conclusions: The SOC-8 guidelines are intended to be flexible to meet the diverse health care needs of TGD people globally. While adaptable, they offer standards for promoting optimal health care and guidance for the treatment of people experiencing gender incongruence. As in all previous versions of the SOC, the criteria set forth in this document for gender-affirming medical interventions are clinical guidelines; individual health care professionals and programs may modify these in consultation with the TGD person.
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Affiliation(s)
- E Coleman
- Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - A E Radix
- Callen-Lorde Community Health Center, New York, NY, USA
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - W P Bouman
- Nottingham Centre for Transgender Health, Nottingham, UK
- School of Medicine, University of Nottingham, Nottingham, UK
| | - G R Brown
- James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
- James H. Quillen VAMC, Johnson City, TN, USA
| | - A L C de Vries
- Department of Child and Adolescent Psychiatry, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M B Deutsch
- Department of Family & Community Medicine, University of California-San Francisco, San Francisco, CA, USA
- UCSF Gender Affirming Health Program, San Francisco, CA, USA
| | - R Ettner
- New Health Foundation Worldwide, Evanston, IL, USA
- Weiss Memorial Hospital, Chicago, IL, USA
| | - L Fraser
- Independent Practice, San Francisco, CA, USA
| | - M Goodman
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - J Green
- Independent Scholar, Vancouver, WA, USA
| | - A B Hancock
- The George Washington University, Washington, DC, USA
| | - T W Johnson
- Department of Anthropology, California State University, Chico, CA, USA
| | - D H Karasic
- University of California San Francisco, San Francisco, CA, USA
- Independent Practice at dankarasic.com
| | - G A Knudson
- University of British Columbia, Vancouver, Canada
- Vancouver Coastal Health, Vancouver, Canada
| | - S F Leibowitz
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - H F L Meyer-Bahlburg
- New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, Columbia University, New York, NY, USA
| | | | - J Motmans
- Transgender Infopunt, Ghent University Hospital, Gent, Belgium
- Centre for Research on Culture and Gender, Ghent University, Gent, Belgium
| | - L Nahata
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
- Endocrinology and Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - T O Nieder
- University Medical Center Hamburg-Eppendorf, Interdisciplinary Transgender Health Care Center Hamburg, Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, Hamburg, Germany
| | - S L Reisner
- Harvard Medical School, Boston, MA, USA
- Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - C Richards
- Regents University London, UK
- Tavistock and Portman NHS Foundation Trust, London, UK
| | | | - V Tangpricha
- Division of Endocrinology, Metabolism & Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Atlanta VA Medical Center, Decatur, GA, USA
| | - A C Tishelman
- Boston College, Department of Psychology and Neuroscience, Chestnut Hill, MA, USA
| | - M A A Van Trotsenburg
- Bureau GenderPRO, Vienna, Austria
- University Hospital Lilienfeld-St. Pölten, St. Pölten, Austria
| | - S Winter
- School of Population Health, Curtin University, Perth, WA, Australia
| | - K Ducheny
- Howard Brown Health, Chicago, IL, USA
| | - N J Adams
- University of Toronto, Ontario Institute for Studies in Education, Toronto, Canada
- Transgender Professional Association for Transgender Health (TPATH)
| | - T M Adrián
- Asamblea Nacional de Venezuela, Caracas, Venezuela
- Diverlex Diversidad e Igualdad a Través de la Ley, Caracas, Venezuela
| | - L R Allen
- University of Nevada, Las Vegas, NV, USA
| | - D Azul
- La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - H Bagga
- Monash Health Gender Clinic, Melbourne, Victoria, Australia
- Monash University, Melbourne, Victoria, Australia
| | - K Başar
- Department of Psychiatry, Hacettepe University, Ankara, Turkey
| | - D S Bathory
- Independent Practice at Bathory International PLLC, Winston-Salem, NC, USA
| | - J J Belinky
- Durand Hospital, Guemes Clinic and Urological Center, Buenos Aires, Argentina
| | - D R Berg
- National Center for Gender Spectrum Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - J U Berli
- Oregon Health & Science University, Portland, OR, USA
| | - R O Bluebond-Langner
- NYU Langone Health, New York, NY, USA
- Hansjörg Wyss Department of Plastic Surgery, New York, NY, USA
| | - M-B Bouman
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Plastic Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - M L Bowers
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mills-Peninsula Medical Center, Burlingame, CA, USA
| | - P J Brassard
- GrS Montreal, Complexe CMC, Montreal, Quebec, Canada
- Université de Montreal, Quebec, Canada
| | - J Byrne
- University of Waikato/Te Whare Wānanga o Waikato, Hamilton/Kirikiriroa, New Zealand/Aotearoa
| | - L Capitán
- The Facialteam Group, Marbella International Hospital, Marbella, Spain
| | | | - J M Carswell
- Harvard Medical School, Boston, MA, USA
- Boston's Children's Hospital, Boston, MA, USA
| | - S C Chang
- Independent Practice, Oakland, CA, USA
| | - G Chelvakumar
- Nationwide Children's Hospital, Columbus, OH, USA
- The Ohio State University, College of Medicine, Columbus, OH, USA
| | - T Corneil
- School of Population & Public Health, University of British Columbia, Vancouver, BC, Canada
| | - K B Dalke
- Penn State Health, PA, USA
- Penn State College of Medicine, Hershey, PA, USA
| | - G De Cuypere
- Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium
| | - E de Vries
- Nelson Mandela University, Gqeberha, South Africa
- University of Cape Town, Cape Town, South Africa
| | - M Den Heijer
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Endocrinology, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - A H Devor
- University of Victoria, Victoria, BC, Canada
| | - C Dhejne
- ANOVA, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - A D'Marco
- UCTRANS-United Caribbean Trans Network, Nassau, The Bahamas
- D M A R C O Organization, Nassau, The Bahamas
| | - E K Edmiston
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - L Edwards-Leeper
- Pacific University, Hillsboro, OR, USA
- Independent Practice, Beaverton, OR, USA
| | - R Ehrbar
- Whitman Walker Health, Washington, DC, USA
- Independent Practice, Maryland, USA
| | - D Ehrensaft
- University of California San Francisco, San Francisco, CA, USA
| | - J Eisfeld
- Transvisie, Utrecht, The Netherlands
| | - E Elaut
- Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium
- Department of Clinical Experimental and Health Psychology, Ghent University, Gent, Belgium
| | - L Erickson-Schroth
- The Jed Foundation, New York, NY, USA
- Hetrick-Martin Institute, New York, NY, USA
| | - J L Feldman
- Institute for Sexual and Gender Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - A D Fisher
- Andrology, Women Endocrinology and Gender Incongruence, Careggi University Hospital, Florence, Italy
| | - M M Garcia
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Departments of Urology and Anatomy, University of California San Francisco, San Francisco, CA, USA
| | - L Gijs
- Institute of Family and Sexuality Studies, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | | | - B P Hall
- Duke University Medical Center, Durham, NC, USA
- Duke Adult Gender Medicine Clinic, Durham, NC, USA
| | - T L D Hardy
- Alberta Health Services, Edmonton, Alberta, Canada
- MacEwan University, Edmonton, Alberta, Canada
| | - M S Irwig
- Harvard Medical School, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - A C Janssen
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - K Johnson
- RMIT University, Melbourne, Australia
- University of Brighton, Brighton, UK
| | - D T Klink
- Department of Pediatrics, Division of Pediatric Endocrinology, Ghent University Hospital, Gent, Belgium
- Division of Pediatric Endocrinology and Diabetes, ZNA Queen Paola Children's Hospital, Antwerp, Belgium
| | - B P C Kreukels
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - L E Kuper
- Department of Psychiatry, Southwestern Medical Center, University of Texas, Dallas, TX, USA
- Department of Endocrinology, Children's Health, Dallas, TX, USA
| | - E J Kvach
- Denver Health, Denver, CO, USA
- University of Colorado School of Medicine, Aurora, CO, USA
| | - M A Malouf
- Malouf Counseling and Consulting, Baltimore, MD, USA
| | - R Massey
- WPATH Global Education Institute
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - T Mazur
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- John R. Oishei Children's Hospital, Buffalo, NY, USA
| | - C McLachlan
- Professional Association for Transgender Health, South Africa
- Gender DynamiX, Cape Town, South Africa
| | - S D Morrison
- Division of Plastic Surgery, Seattle Children's Hospital, Seattle, WA, USA
- Division of Plastic Surgery, Department of Surgery, University of Washington Medical Center, Seattle, WA, USA
| | - S W Mosser
- Gender Confirmation Center, San Francisco, CA, USA
- Saint Francis Memorial Hospital, San Francisco, CA, USA
| | - P M Neira
- Johns Hopkins Center for Transgender Health, Baltimore, MD, USA
- Johns Hopkins Medicine Office of Diversity, Inclusion and Health Equity, Baltimore, MD, USA
| | - U Nygren
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Speech and Language Pathology, Medical Unit, Karolinska University Hospital, Stockholm, Sweden
| | - J M Oates
- La Trobe University, Melbourne, Australia
- Melbourne Voice Analysis Centre, East Melbourne, Australia
| | - J Obedin-Maliver
- Stanford University School of Medicine, Department of Obstetrics and Gynecology, Palo Alto, CA, USA
- Department of Epidemiology and Population Health, Stanford, CA, USA
| | - G Pagkalos
- Independent PracticeThessaloniki, Greece
- Military Community Mental Health Center, 424 General Military Training Hospital, Thessaloniki, Greece
| | - J Patton
- Talkspace, New York, NY, USA
- CytiPsychological LLC, San Diego, CA, USA
| | - N Phanuphak
- Institute of HIV Research and Innovation, Bangkok, Thailand
| | - K Rachlin
- Independent Practice, New York, NY, USA
| | - T Reed
- Gender Identity Research and Education Society, Leatherhead, UK
| | - G N Rider
- National Center for Gender Spectrum Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - J Ristori
- Andrology, Women Endocrinology and Gender Incongruence, Careggi University Hospital, Florence, Italy
| | | | - S A Roberts
- Harvard Medical School, Boston, MA, USA
- Division of Endocrinology, Boston's Children's Hospital, Boston, MA, USA
| | - K A Rodriguez-Wallberg
- Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | - S M Rosenthal
- Division of Pediatric Endocrinology, UCSF, San Francisco, CA, USA
- UCSF Child and Adolescent Gender Center
| | - K Sabir
- FtM Phoenix Group, Krasnodar Krai, Russia
| | - J D Safer
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mount Sinai Center for Transgender Medicine and Surgery, New York, NY, USA
| | - A I Scheim
- Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
- Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, Ontario, Canada
| | - L J Seal
- Tavistock and Portman NHS Foundation Trust, London, UK
- St George's University Hospitals NHS Foundation Trust, London, UK
| | | | - K Spencer
- National Center for Gender Spectrum Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - C St Amand
- University of Houston, Houston, TX, USA
- Mayo Clinic, Rochester, MN, USA
| | - T D Steensma
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - J F Strang
- Children's National Hospital, Washington, DC, USA
- George Washington University School of Medicine, Washington, DC, USA
| | - G B Taylor
- Atrium Health Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Charlotte, NC, USA
| | - K Tilleman
- Department for Reproductive Medicine, Ghent University Hospital, Gent, Belgium
| | - G G T'Sjoen
- Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium
- Department of Endocrinology, Ghent University Hospital, Gent, Belgium
| | - L N Vala
- Independent Practice, Campbell, CA, USA
| | - N M Van Mello
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - J F Veale
- School of Psychology, University of Waikato/Te Whare Wānanga o Waikato, Hamilton/Kirikiriroa, New Zealand/Aotearoa
| | - J A Vencill
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - B Vincent
- Trans Learning Partnership at https://spectra-london.org.uk/trans-learning-partnership, UK
| | - L M Wesp
- College of Nursing, University of Wisconsin MilwaukeeMilwaukee, WI, USA
- Health Connections Inc., Glendale, WI, USA
| | - M A West
- North Memorial Health Hospital, Robbinsdale, MN, USA
- University of Minnesota, Minneapolis, MN, USA
| | - J Arcelus
- School of Medicine, University of Nottingham, Nottingham, UK
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
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Mehra G, Boskey ER, Peters CJ, Njubigbo C, Charlton BM, Ganor O. Assessing Fertility Intentions in Patients Presenting for Gender-Affirming Surgery. LGBT Health 2022; 9:325-332. [PMID: 35749209 DOI: 10.1089/lgbt.2021.0148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: For some transgender and gender-diverse (TGD) individuals, gender-affirming surgery may represent the last opportunity to engage in gamete banking (GB) and other forms of fertility preservation (FP). Previous research has assessed fertility intentions among TGD people initiating hormone therapy. The objective of this study was to describe the fertility intentions of patients seeking gender-affirming surgery. Methods: A retrospective chart review was conducted for 233 patients seeking chest or genital surgery between 2017 and 2019. Data abstracted included interest in having children (biological or non-biological) and GB, and barriers to FP. Associations between fertility intentions, sex assigned at birth, and surgical procedure sought were assessed. Results: Of the 233 records reviewed, 162 (70%) documented information about fertility intentions for patients without a history of sterilizing surgery. At initial consultation, 94% were receiving hormone therapy. Among the 60 patients seeking genital surgery, 30% expressed interest in GB and 38% were not interested in biological children. Among the 102 patients seeking chest surgery, 11% expressed interest in GB and 47% were not interested in biological children. Patients assigned male at birth were more likely to have already completed GB (p < 0.001). Among the patients interested in FP, 41% reported barriers to access. Conclusion: Many TGD people in our study expressed no interest in biological parenthood; however, 30% of patients seeking genital surgery expressed interest in GB. This suggests that some who defer FP when starting hormones may wish to pursue it later in life. Ongoing assessment of fertility intentions and reducing barriers to FP are integral to caring for TGD people.
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Affiliation(s)
| | - Elizabeth R Boskey
- Center for Gender Surgery, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston Massachusetts, USA
| | - Carson J Peters
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Chinelo Njubigbo
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Brittany M Charlton
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Division of Adolescent Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Oren Ganor
- Center for Gender Surgery, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston Massachusetts, USA
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Fertility Preservation for Transgender Males. Obstet Gynecol 2022; 139:1012-1017. [DOI: 10.1097/aog.0000000000004751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/03/2022] [Indexed: 10/18/2022]
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Giacomozzi M, Health MSG, Aubin SG, Brancaccio MT. Mapping Accessibility to Fertility Preservation for Trans Masculine Individuals in the Netherlands. LGBT Health 2022; 9:369-383. [PMID: 35533011 DOI: 10.1089/lgbt.2021.0302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Since 2014 in the Netherlands, sterilization is no longer required for legal gender affirmation. Access to fertility preservation (FP) options is indispensable to grant equal reproductive rights to this population. This study aims to map existing literature on barriers and enabling factors for trans masculine individuals to access FP in the Netherlands after 2014. Methods: A scoping review method was conducted, including a database and a hand search complemented with informal consultations. Literature between 2014 and 2021 was searched. Results: A total of 38 peer-reviewed articles and 22 complementary gray literature sources were retrieved. Thematic analysis identified seven common themes: biological, psychological, training, language, law and legislation, economic, and sociocultural. The themes were clustered as patient-, health care provider (HCP)- and environment-related. Conclusion: The Netherlands offers progressive legislation and accommodating insurance agreements that favor FP for trans masculine individuals. However, the current readiness of HCPs to provide adapted and tailored care is arguable, and the capacity to access appropriate health services for trans masculine individuals is largely nonexistent outside of highly specialized health institutions. The implementation of both formal and informal education training programs for HCPs on transgender and gender diverse health needs-as well as inclusive language use-could benefit this community at large.
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Affiliation(s)
| | - MSc Global Health
- Department of Health, Ethics and Society, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | | | - Maria Teresa Brancaccio
- Department of Health, Ethics and Society, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
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Raja NS, Russell CB, Moravek MB. Assisted reproductive technology: considerations for the nonheterosexual population and single parents. Fertil Steril 2022; 118:47-53. [DOI: 10.1016/j.fertnstert.2022.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/30/2022] [Accepted: 04/06/2022] [Indexed: 11/29/2022]
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Israeli T, Preisler L, Kalma Y, Samara N, Levi S, Groutz A, Azem F, Amir H. Similar fertilization rates and preimplantation embryo development among testosterone-treated transgender men and cisgender women. Reprod Biomed Online 2022; 45:448-456. [DOI: 10.1016/j.rbmo.2022.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 04/13/2022] [Accepted: 04/26/2022] [Indexed: 11/25/2022]
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Morong JJ, Class QA, Zamah AM, Hinz E. Parenting intentions in transgender and gender-nonconforming adults. Int J Gynaecol Obstet 2022; 159:557-562. [PMID: 35332529 DOI: 10.1002/ijgo.14194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 03/14/2022] [Accepted: 03/23/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To assess parenting intentions, knowledge and attitudes regarding fertility preservation, and barriers to achieving parenthood in an adult transgender population. METHODS This was a multi-center online cross-sectional study conducted at three university-affiliated and 15 community-affiliated clinics within a major US city. Inclusion criteria included being aged 18 years and older and self-identification as transgender, gender non-conforming or non-binary. Eighty respondents completed a 36-question survey regarding their transition and plans to achieve parenthood. We compared demographic characteristics to plan for transition using Chi-Square analysis. We compared options to achieve parenthood to plans for transition using ANOVA, Spearman's rho correlation coefficient, and a Kruskal Wallis H test. RESULTS The mean desire to become a parent was 59.9 on a scale of 1-100. There was no significant association between plan for gonadectomy and reduced preference for the use of autologous gametes for parenting [H(2) = 1.309, P = 0.520]. The desire to have children was correlated with an increasing willingness to pause cross-sex hormones (rs = 0.40, P < 0.01). Cost was identified as the largest barrier to fertility preservation (54.1%). CONCLUSION The majority of transgender adults surveyed desire parenthood and this could be correlated with plan for transition including willingness to suspend cross-sex hormones.
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Affiliation(s)
- James J Morong
- Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Quetzal A Class
- Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Alberuni Musa Zamah
- Department of Obstetrics and Gynecology, Section of Reproductive Endocrinology and Infertility, The University of Chicago, Chicago, Illinois, USA
| | - Erica Hinz
- Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, Illinois, USA
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Durcan E, Turan S, Bircan BE, Yaylamaz S, Okur I, Demir AN, Sulu C, Kara Z, Sahin S, Taze SS, Mefkure Ozkaya H, Kadioglu P. Fertility Desire and Motivation Among Individuals with Gender Dysphoria: A Comparative Study. JOURNAL OF SEX & MARITAL THERAPY 2022; 48:789-803. [PMID: 35332854 DOI: 10.1080/0092623x.2022.2053617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Despite receiving Gender-Affirming Hormone Therapy or Gender-Affirming Surgery, which may adversely impact their fertility, people with Gender Dysphoria (GD) may desire to form families. In this study, we aimed to quantitatively display fertility desire from the perspective of these individuals, despite all the legal challenges they face. The single center, cross-sectional comparative study included individuals with GD and cisgender volunteers. A Sociodemographic Data Form, the Fertility Desire Data Form, the Childbearing Motivations Scale and the Fertility Desire Scale were used. Of the 414 participants, 171 were individuals with GD (110 FtM; 61 MtF) and 243 were cisgender volunteers (142 cis-males; 101 cis-females). While 22% of the people with GD stated that they had regrets about not undergoing fertility preservation, 16% stated that they would like this process if it were legal. People with GD, particularly MtF, want to have children more than cisgenders. Moreover, people with MtF exhibited less negative motivations toward becoming parents, despite having reservations regarding the socioeconomic aspect of parenthood. Our findings indicate that fertility desire in people with GD is not less in comparison to cisgender people. Healthcare professionals should not forget to offer fertility preservation options as part of clinical practice before Gender-Affirming Therapy.
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Affiliation(s)
- Emre Durcan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Senol Turan
- Department of Psychiatry, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Basak Ecem Bircan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Selver Yaylamaz
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ihsan Okur
- Department of Psychiatry, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ahmet Numan Demir
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Cem Sulu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Zehra Kara
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Serdar Sahin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Sabriye Sibel Taze
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Hande Mefkure Ozkaya
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Pinar Kadioglu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Cooper HC, Long J, Aye T. Fertility preservation in transgender and non-binary adolescents and young adults. PLoS One 2022; 17:e0265043. [PMID: 35275955 PMCID: PMC8916634 DOI: 10.1371/journal.pone.0265043] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 02/22/2022] [Indexed: 11/18/2022] Open
Abstract
Although 37.5–51% of transgender adults state they would’ve considered freezing gametes before gender-affirming therapy if offered and 24–25.8% of transgender adolescents express interest in having biological children, less than 5% of transgender adolescents have opted for fertility preservation. We sought to assess fertility preservation utilization in our multidisciplinary adolescent gender clinic. We also aimed to identify fertility preservation utilization and interest among non-binary adolescents and young adults. A retrospective review was conducted of patients seen in the Stanford Pediatric & Adolescent Gender Clinic from October 2015 through March 2019 who were >10 years of age at initial visit. All individuals with documented discussion of fertility preservation were offered referral for formal fertility preservation consultation but only 24% of patients accepted. Only 6.8% of individuals subsequently underwent fertility preservation (n = 9). Transfeminine adolescents are more likely to pursue fertility preservation than transmasculine adolescents (p = 0.01). The rate of fertility preservation in non-binary adolescents did not significantly differ from those in transfeminine adolescents (p = 1.00) or transmasculine adolescents (p = 0.31). Although only one non-binary individual underwent fertility preservation, several more expressed interest with 36% accepting referral (n = 4) and 27% being seen in consultation (n = 3). Despite offering fertility preservation with designated members of a gender clinic team, utilization remains low in transgender adolescents. Additionally, non-binary adolescents and their families are interested in fertility preservation and referrals should be offered to these individuals. Further studies and advocacy are required to continue to address fertility needs of transgender adolescents.
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Affiliation(s)
- Holly C. Cooper
- Department of Pediatric Endocrinology, Mary Bridge Children’s Hospital, Tacoma, Washington, United States of America
- * E-mail:
| | - Jin Long
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, United States of America
| | - Tandy Aye
- Department of Pediatric Endocrinology, Mary Bridge Children’s Hospital, Tacoma, Washington, United States of America
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Rodriguez-Wallberg K, Obedin-Maliver J, Taylor B, Van Mello N, Tilleman K, Nahata L. Reproductive health in transgender and gender diverse individuals: A narrative review to guide clinical care and international guidelines. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2022; 24:7-25. [PMID: 36713139 PMCID: PMC9879176 DOI: 10.1080/26895269.2022.2035883] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Background Hormonal treatments and surgical interventions practiced with the aim to affirm gender identity in transgender and gender diverse patients may impact their future reproductive ability, family building, and family planning options. Whereas it is recommended by international guidelines to discuss the potential risks of infertility and to present fertility preservation (FP) options to transgender individuals and their families prior to initiating any of these treatments, many barriers still remain. Further, transgender and gender diverse individuals often experience barriers to accessing contraception, abortion, pre-conception care, and comprehensive perinatal care. Aims In this review we summarize the current literature on reproductive healthcare issues reported in transgender people including fertility issues, fertility preservation (FP), contraception, pregnancy and lactation and perinatal health. Methods A narrative literature search of major databases (Pubmed, Medline, PsycInfo, Google Scholar, Web of Science) was conducted. Given the paucity and heterogeneity of studies, summative review tactics were not available. The literature was critically reviewed by international experts in the field with focus on the impact of gender-affirming medical interventions on future fertility, current FP options and reproductive health issues in transgender people. Results The current literature supports that transgender and gender diverse individuals may wish to have genetically related children in the future, rendering the issue of FP relevant to this patient group. The cryopreservation of mature gametes is an efficacious option for FP for post-pubertal adolescents and adults. It is recommended to discuss these options at time of planning for gender-affirming hormonal therapy (GAHT) or engaging with other gender-affirming procedures that can limit future fertility. Discontinuation of GAHT may allow individuals to undergo FP later, but data are limited and there is the concern of symptoms and consequences of stopping GAHT. For pre-pubertal and early pubertal children, FP options are limited to the cryopreservation of gonadal tissue. At present the tissue can become functional only after re-transplantation, which might be undesirable by transgender individuals in the future. Preconception counseling, prenatal surveillance, perinatal support, contraceptive, and pregnancy termination related healthcare need to be meaningfully adapted for this patient population, and many knowledge gaps remain. Discussion Specialized FP reproductive healthcare for transgender and gender diverse individuals is in early evolution. Research should be conducted to examine effects of medical interventions on fertility, timing of FP, gamete preservation and outcome of the fertility treatments. Strategies to inform and educate transgender and gender diverse patients can lead to optimization of reproductive care and counseling and decision making of FP for this population.
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Affiliation(s)
- Kenny Rodriguez-Wallberg
- Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pahology, Karolinska Institutet, Stockholm, Sweden
- Laboratory of Translational Fertility Preservation, NKS, Stockholm, Sweden
| | - Juno Obedin-Maliver
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Bernard Taylor
- Department of Obstetrics and Gynecology, Atrium Health, Charlotte, NC, USA
| | - Norah Van Mello
- Department of Obstetrics and Gynecology and Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Kelly Tilleman
- Department for Reproductive Medicine, Ghent University Hospital, Ghent, Belgium
| | - Leena Nahata
- Center for Biobehavioral Health, The Abigail Wexner Research Institute, Columbus, OH, USA
- Division of Pediatric Endocrinology, Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
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Borrás A, Manau D, Fabregues F, Peralta S, Calafell JM, Casals G, Saco A, Agustí I, Carmona F. Comparison between slow freezing and vitrification of ovarian tissue cryopreservation in assigned female at birth transgender people receiving testosterone therapy: data on histological and viability parameters. J Assist Reprod Genet 2022; 39:527-541. [PMID: 35098405 PMCID: PMC8956766 DOI: 10.1007/s10815-021-02386-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 12/20/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The use of fertility preservation (FP) techniques has significantly increased in recent years in the assigned female at birth (AFAB) transgender population. Oocyte cryopreservation is the established method for FP, but ovarian tissue cryopreservation may be considered an alternative option, especially during gender-affirming surgery (GAS). The slow freezing (SF) cryopreservation technique is the standard method for human ovarian tissue, but recently, several studies have shown good results with the vitrification (VT) technique. The objective of this study was to compare the effectiveness of VT and SF techniques in ovarian tissue from AFAB transgender people. METHODS This was a prospective study including 18 AFAB transgender people after GAS. Ovarian tissue pieces from each ovary were cryopreserved by SF and VT and compared with fresh tissue. Study by light microscopy (LM) assessed follicular morphology and density. The percentage of surviving and degenerated follicles was studied with the tissue viability test. Oocytes, granulosa cells and stroma were analysed separately by transmission electron microscopy. RESULTS The VT technique preserves follicle and stromal tissue as well as the SF method, but with some differences. Evaluation by LM showed better follicle preservation with VT, but the ultrastructural study showed the presence of minor damage with both techniques compared to fresh tissue. CONCLUSION Both cryopreservation techniques are accurate for maintaining the follicular population and stromal tissue. Further studies are needed to determine the impact of VT on ovarian tissue and the subsequent follicular activation mechanisms in AFAB ovarian tissue.
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Affiliation(s)
- Aina Borrás
- Assisted Reproduction Unit, Clinical Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clínic de Barcelona, Carrer de Villarroel N° 170, 08036 Barcelona, Spain
| | - Dolors Manau
- Assisted Reproduction Unit, Clinical Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clínic de Barcelona, Carrer de Villarroel N° 170, 08036 Barcelona, Spain ,Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Francesc Fabregues
- Assisted Reproduction Unit, Clinical Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clínic de Barcelona, Carrer de Villarroel N° 170, 08036 Barcelona, Spain ,Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Sara Peralta
- Assisted Reproduction Unit, Clinical Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clínic de Barcelona, Carrer de Villarroel N° 170, 08036 Barcelona, Spain
| | - Josep Maria Calafell
- Assisted Reproduction Unit, Clinical Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clínic de Barcelona, Carrer de Villarroel N° 170, 08036 Barcelona, Spain
| | - Gemma Casals
- Assisted Reproduction Unit, Clinical Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clínic de Barcelona, Carrer de Villarroel N° 170, 08036 Barcelona, Spain ,Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Adela Saco
- Department of Pathology, Hospital Clinic, University of Barcelona, Barcelona, Spain ,Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Inés Agustí
- Assisted Reproduction Unit, Clinical Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clínic de Barcelona, Carrer de Villarroel N° 170, 08036 Barcelona, Spain
| | - Francisco Carmona
- Assisted Reproduction Unit, Clinical Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clínic de Barcelona, Carrer de Villarroel N° 170, 08036 Barcelona, Spain ,Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Cabar FR, de Oliveira MA, Machado ANC. Critical Analysis of The Changes in CFM Resolution 2294/21 And Its Impacts on Assisted Human Reproduction. JBRA Assist Reprod 2022; 26:659-665. [PMID: 35416023 PMCID: PMC9635607 DOI: 10.5935/1518-0557.20220007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The Brazilian Federal Board of Medicine (CFM) issued resolution number 2294/21, which regulates human reproduction procedures in Brazil, bringing significant changes to clinical practice in assisted human reproduction, and it raised ethical, bioethical, and legal discussions between professionals and patients. This study aims to analyze these changes in different aspects, especially because some of them are controversial. Evidence-based knowledge resources were used to support the analyses of crucial points that were impacted by this change. A literature review was carried out to obtain information about guidelines and laws, as well as articles that contemplate ethical discussions on assisted reproduction. The search sites used were BVS, Pub Med, LILACS and Google Scholar. The keywords used were law, legislation, bioethics, reference guide and assisted human reproduction. Relevant official documents from the Brazilian State were also found and included in the survey. The new resolution regarding the use of assisted reproduction techniques brought important changes, with clinical implications for couples who wish to become pregnant, and there is a need for a broad discussion concerning these repercussions from clinical, ethical, bioethical, and legal points of view.
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Affiliation(s)
- Fabio Roberto Cabar
- Faculdade de Medicina da Universidade de São Paulo -
Departamento de Obstetrícia e Ginecologia. São Paulo, SP, Brazil ,Corresponding Author: Fábio Roberto Cabar,
Secretaria da Divisão de Clínica Obstétrica, University of
Sao Paulo School of Medicine, São Paulo, SP, Brazil,
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Greenwald P, Dubois B, Lekovich J, Pang JH, Safer J. Successful In Vitro Fertilization in a Cisgender Female Carrier Using Oocytes Retrieved From a Transgender Man Maintained on Testosterone. AACE Clin Case Rep 2022; 8:19-21. [PMID: 35097196 PMCID: PMC8784719 DOI: 10.1016/j.aace.2021.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 06/02/2021] [Accepted: 06/07/2021] [Indexed: 11/29/2022] Open
Abstract
Background Health care providers routinely discontinue testosterone in transgender men undergoing oocyte retrieval. To date, there is little literature to support such discontinuation. The sudden drop in testosterone levels can be distressing for transgender men. The objective of this report was to describe a case study of successful reciprocal in vitro fertilization (IVF) using oocytes retrieved from a transgender man who remained on testosterone during the entire course of gonadotropin controlled ovarian stimulation and retrieval. Case Report A 33-year-old gravida 0 transgender man and his partner, a 42-year-old gravida 0 cisgender woman, presented to an outpatient clinic in 2017 seeking reciprocal IVF. Both patients were healthy with no significant past medical history. The transgender patient reported a 10-year history of testosterone hormone therapy. Both patients reported no other medication use. The transgender man underwent a 14-day course of ovarian stimulation before oocytes were retrieved. An oocyte was then fertilized and implanted into the uterus of the patient’s cisgender female partner. The reciprocal IVF resulted in an uncomplicated, full-term pregnancy with vaginal delivery. The child is now 2 years old and developmentally normal. Discussion To our knowledge, this is the first report of a live birth from an oocyte retrieved from a transgender man who continued to use testosterone throughout assisted reproduction. Conclusion Fertility preservation options for transmasculine people may include stimulated egg retrieval if the ovaries are left in place even when the patients remain on testosterone therapy.
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Affiliation(s)
- Phoebe Greenwald
- Vagelos College of Physicians and Surgeons at Columbia University, New York, New York
| | - Bethany Dubois
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jovana Lekovich
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai
| | - John Henry Pang
- Icahn School of Medicine at Mount Sinai, New York, New York
- Center for Transgender Medicine and Surgery, Mount Sinai Health System, New York, New York
| | - Joshua Safer
- Icahn School of Medicine at Mount Sinai, New York, New York
- Center for Transgender Medicine and Surgery, Mount Sinai Health System, New York, New York
- Address correspondence to Dr Joshua Safer, Center for Transgender Medicine and Surgery, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, 275 7th Avenue, 15th Floor, New York, New York 10001.
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Barrett F, Shaw J, Blakemore JK, Fino ME. Fertility Preservation for Adolescent and Young Adult Transmen: A Case Series and Insights on Oocyte Cryopreservation. Front Endocrinol (Lausanne) 2022; 13:873508. [PMID: 35685214 PMCID: PMC9171925 DOI: 10.3389/fendo.2022.873508] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/07/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The opportunity for fertility preservation in adolescent and young adult (AYA) transmen is growing. Many AYA transmen desire future biologic children and are interested in ways to preserve fertility through oocyte cryopreservation prior to full gender affirmation, yet utilization of oocyte cryopreservation remains low. Additionally, standard practice guidelines currently do not exist for the provision of oocyte cryopreservation to AYA transmen. Our objective was to review our experience with oocyte cryopreservation in adolescent and young adult transmen in order to synthesize lessons regarding referral patterns, utilization, and oocyte cryopreservation outcomes as well as best practices to establish treatment guidance. METHODS This is a case series of all AYA transmen (aged 10 to 25 years) who contacted, consulted or underwent oocyte cryopreservation at a single high volume New York City based academic fertility center between 2009 and 2021. RESULTS Forty-four adolescent and young adult transmen made contact to the fertility center over the study period. Eighty percent (35/44) had a consultation with a Reproductive and Endocrinology specialist, with a median age of 16 years (range 10 to 24 years) at consultation. The majority were testosterone-naive (71%, 25/35), and had not pursued gender affirming surgery (86%, 30/35). Expedited initiation of testosterone remained the most commonly cited goal (86%, 30/35). Fifty-seven percent (20/35) pursued oocyte cryopreservation. Ninety-five percent (19/20) underwent successful transvaginal oocyte aspiration, with a median of 22 oocytes retrieved and 15 mature oocytes cryopreserved. There were no significant adverse events. At time of review, no patient has returned to utilize their cryopreserved oocytes. CONCLUSIONS Oocyte cryopreservation is a safe fertility preservation option in AYA transmen and is an important aspect of providing comprehensive transgender care. Insights from referral patterns, utilization, and oocyte cryopreservation outcomes from a single center's experience with adolescent and young adult transmen can be integrated to identify lessons learned with the goal of providing transparency surrounding the oocyte cryopreservation process, improving the education and comfort of patients and providers with fertility preservation, and easing the decision to pursue an oocyte cryopreservation cycle in parallel to gender-affirmatory care.
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Affiliation(s)
- Francesca Barrett
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, NY, United States
| | - Jacquelyn Shaw
- Department of Reproductive Endocrinology and Infertility, New York University Langone Fertility Center, New York, NY, United States
| | - Jennifer K. Blakemore
- Department of Reproductive Endocrinology and Infertility, New York University Langone Fertility Center, New York, NY, United States
| | - Mary Elizabeth Fino
- Department of Reproductive Endocrinology and Infertility, New York University Langone Fertility Center, New York, NY, United States
- *Correspondence: Mary Elizabeth Fino,
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Kirczenow MacDonald T, Walks M, Biener M, Kibbe A. Disrupting the norms: Reproduction, gender identity, gender dysphoria, and intersectionality. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2021; 22:18-29. [PMID: 34918009 PMCID: PMC8040682 DOI: 10.1080/26895269.2020.1848692] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Background: In western cultures, pregnancy and birth have typically been viewed as inherently feminine activities. However, some transmasculine individuals desire and undergo pregnancy. Aims: Our study aimed to explore the experiences of transmasculine individuals with pregnancy and birth. Methods: We conducted 22 qualitative interviews and four follow-up interviews with transmasculine individuals who had experienced one or more pregnancies. Our analysis was guided by an intersectional approach, and was led by a transgender community member. Results: The interviews focused on stories about how the study participants built their families and navigated health care systems in the context of being pregnant transgender persons. As part of a larger study that considered the pregnancy, birth and infant feeding experiences of transmasculine individuals, this paper examines three themes that emerged from the narratives: experiences of gender dysphoria, addressing the gender binary, and intersectionality. Discussion: Experiences of gender dysphoria among transmasculine individuals during pregnancy and birth vary widely. Some trans individuals experience pregnancy as congruent with their masculine gender identity. However, participants reported that some health care providers' strong belief in the gender binary led to inappropriate and oppressive reproductive and perinatal health care.
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Affiliation(s)
| | - Michelle Walks
- Department of Social Sciences, Alexander College, Burnaby, British Columbia, Canada
| | | | - Alanna Kibbe
- Seventh Generation Midwives Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Wilde M, Huguelet P, Alaniz VI. Transgender Medicine and Hormone Therapy: What the Gynecologist Needs to Know. Clin Obstet Gynecol 2021; 64:739-756. [PMID: 34292172 DOI: 10.1097/grf.0000000000000646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The transgender community comprises individuals with diverse identities in both gender and sexual orientation. Unfortunately, many face discrimination and harassment within our society-including within the medical system. There is an overall lack of provider training in transgender specific health which has led to health disparities and inequities within this population. This chapter aims to elucidate the medical needs unique to transgender and gender nonconforming individuals and thus enable medical providers to meet those needs with competency and compassion.
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Affiliation(s)
- Melyssa Wilde
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado
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Kimberly L, Folkers KM, Karrington B, Wernick J, Busa S, Salas-Humara C. Navigating Evolving Ethical Questions in Decision Making for Gender-Affirming Medical Care for Adolescents. THE JOURNAL OF CLINICAL ETHICS 2021. [DOI: 10.1086/jce2021324307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Agénor M, Murchison GR, Najarro J, Grimshaw A, Cottrill AA, Janiak E, Gordon AR, Charlton BM. Mapping the scientific literature on reproductive health among transgender and gender diverse people: a scoping review. Sex Reprod Health Matters 2021; 29:1886395. [PMID: 33625311 PMCID: PMC8011687 DOI: 10.1080/26410397.2021.1886395] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
We conducted a scoping review to map the extent, range and nature of the scientific research literature on the reproductive health (RH) of transgender and gender diverse assigned female at birth and assigned male at birth persons. A research librarian conducted literature searches in Ovid MEDLINE®, Ovid Embase, the Cochrane Library, PubMed, Google Scholar, Gender Studies Database, Gender Watch, and Web of Science Core Collection. The results were limited to peer-reviewed journal articles published between 2000 and 2018 involving human participants, written in English, pertaining to RH, and including disaggregated data for transgender and gender diverse people. A total of 2197 unique citations with abstracts were identified and entered into Covidence. Two independent screeners performed a title and abstract review and selected 75 records for full-text review. The two screeners independently extracted data from 37 eligible articles, which were reviewed, collated, summarised, and analysed using a numerical summary and thematic analysis approach. The existing scientific research literature was limited in terms of RH topics, geographic locations, study designs, sampling and analytical strategies, and populations studied. Research is needed that: focuses on the full range of RH issues; includes transgender and gender diverse people from the Global South and understudied and multiply marginalised subpopulations; is guided by intersectionality; and uses intervention, implementation science, and community-based participatory research approaches. Further, programmes, practices, and policies that address the multilevel barriers to RH among transgender and gender diverse people addressed in the existing scientific literature are warranted.
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Affiliation(s)
- Madina Agénor
- Gerald R. Gill Assistant Professor, Department of Community Health, Tufts University, Medford, MA, USA; Adjunct Faculty, Department of Obstetrics and Gynecology, Tufts University School of Medicine, and The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Gabriel R. Murchison
- PhD Student, Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Jesse Najarro
- Undergraduate Student, Department of Community Health, Tufts University, Medford, MA, USA
| | - Alyssa Grimshaw
- Clinical Research and Education Librarian, Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT, USA
| | - Alischer A. Cottrill
- Research Coordinator, Planned Parenthood League of Massachusetts, Boston, MA, USA
| | - Elizabeth Janiak
- Director of Social Science Research, Planned Parenthood League of Massachusetts, Boston, MA, USA; Assistant Professor, Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women’s Hospital, Boston, MA, USA and Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA, USA; Instructor, Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Allegra R. Gordon
- Assistant Professor, Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA; Instructor, Division of Adolescent and Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA, and Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Brittany M. Charlton
- Assistant Professor, Division of Adolescent and Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA, Department of Pediatrics, Harvard Medical School, Boston, MA, USA and Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
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Verma K, Sagun BK, Rasouli MA, Duke CM. Social media engagement with transgender fertility content. F S Rep 2021; 3:100-105. [PMID: 35937448 PMCID: PMC9349237 DOI: 10.1016/j.xfre.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 12/13/2021] [Accepted: 12/16/2021] [Indexed: 11/30/2022] Open
Abstract
Objective Design Setting Patient(s) Intervention(s) Main Outcome Measure(s) Result(s) Conclusion(s)
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Affiliation(s)
- Kajal Verma
- Department of Obstetrics and Gynecology, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada
- Correspondence: Kajal Verma, M.D., Department of Obstetrics and Gynecology, Kirk Kerkorian School of Medicine at UNLV, 1701 W Charleston Blvd., Ste. 29, Las Vegas, Nevada 89102.
| | | | - Melody A. Rasouli
- Department of Obstetrics and Gynecology, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada
| | - Cindy M. Duke
- Department of Obstetrics and Gynecology, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada
- Nevada Fertility Institute, Las Vegas, Nevada
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Fischer OJ. Non-binary reproduction: Stories of conception, pregnancy, and birth. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2021; 22:77-88. [PMID: 34755150 PMCID: PMC8040674 DOI: 10.1080/26895269.2020.1838392] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Background: Many non-binary individuals AFAB (assigned female at birth) seek gestational parenthood. However, the limited available literature is often focused on trans men and overlooks the conception, pregnancy, and birth experiences of non-binary parents. Aims: The study aimed to capture the unique reproduction narratives of non-binary people AFAB. Methods: Five non-binary individuals volunteered to participate in this study. Data were collected using largely unstructured, in-depth, tape-recorded interviews. Thematic analysis of the verbatim transcripts and tape recordings yielded a chronological, cohesive narrative for each participant. Four participants reviewed their narrative and confirmed that their story was accurately represented. The individual narratives were then woven into one collective narrative, and common themes across the participants' stories were identified. Results: Before conception, most participants considered how to balance their medical and social transitions with their reproductive goals. Conception was relatively easy and straightforward for the four participants who used their partner's sperm. The gendered nature of, and language surrounding, pregnancy greatly impacted participant's reproductive experiences, leading to feelings of isolation and loneliness, difficulties finding maternity clothes and gender dysphoria. Participants desired gender-affirming care and reported mostly positive experiences with their healthcare providers. Their gender identity influenced their experiences of parenthood, as well as the decisions they made regarding the disclosure of their gender identity to others, their gender presentation, chestfeeding, and parental designations. Discussion: The cisnormative and heteronormative scripts that surround pregnancy shaped the reproductive narratives of those who participated in this research. The findings reinforce the importance of inclusive, gender-affirming healthcare and social support services.
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Affiliation(s)
- Olivia J. Fischer
- Faculty of Education, Department of Educational and Counselling Psychology, and Special Education, University of British Columbia, Vancouver, British Columbia, Canada
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Quinn GP, Tishelman AC, Chen D, Nahata L. Reproductive health risks and clinician practices with gender diverse adolescents and young adults. Andrology 2021; 9:1689-1697. [PMID: 33942552 PMCID: PMC8566321 DOI: 10.1111/andr.13026] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Reproductive health counseling is essential for adolescents and young adults (AYAs). Transgender and gender diverse (TGD) AYAs would benefit from tailored counseling given concerns about iatrogenic infertility and sexual dysfunction, and high rates of interpersonal violence, unplanned pregnancies and sexually transmitted infections, yet there are multiple obstacles to providing this care at the patient/family and clinician levels. OBJECTIVES This narrative review summarizes the literature on reproductive health considerations for TGD AYAs, current practices, and clinician barriers and facilitators to providing culturally sensitive reproductive care for TGD AYAs. Specific areas of focus include reproductive health goals, risks, and access barriers; clinician knowledge practices and challenges; and strategies for improving counseling practices. MATERIALS AND METHODS PubMed, Google Scholar, Medline, Web of Science, and PsycInfo databases were searched using the following terms: transgender, non-binary, gender expansive, gender non-conforming, reproductive health, sexual health, fertility, family planning/building, contraception, sexual dysfunction; gender-affirming hormones/surgery, clinician, physician or provider knowledge and attitudes; counseling. RESULTS Many TGD AYAs desire biological children and improved sexual experiences. TGD AYAs may experience infertility and sexual dysfunction associated with transition; have disproportionate HIV/STI risk; experience high rates of interpersonal/sexual violence and trauma; and encounter barriers to accessing competent medical care. Clinicians lack knowledge about reproductive health needs of TGD AYAs; inconsistently discuss family building options; perceive counseling challenges; and desire more training in this area. DISCUSSION Enriched communication training for medical/mental health clinicians is necessary to provide a skilled workforce for TGD AYAs. Web-based reproductive health training with other populations (eg oncology) demonstrates efficacy for improving communication skills and confidence in counseling, CONCLUSION: This review highlights barriers to adequate reproductive care encountered by TGD AYAs, exacerbated in underserved minority youth. Dedicated training for providers, and programs increasing access are important goals for improving care. The need for additional research is also emphasized.
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Affiliation(s)
- Gwendolyn P. Quinn
- Grossman School of Medicine, Departments of OB-GYN and Population Health, NY, NY, USA
| | - Amy C. Tishelman
- Boston Children’s Hospital, Departments of Psychiatry and Endocrinology, Boston, MA, USA
- Harvard Medical School, Departments of Psychiatry and Endocrinology, Boston, MA, USA
| | - Diane Chen
- Potocsnak Family Division of Adolescent and Young Adult Medicine, and Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
- Departments of Psychiatry and Behavioral Sciences, and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Leena Nahata
- Department of Pediatrics, The Ohio State University College of Medicine; Section of Endocrinology, Nationwide Children’s Hospital, Columbus, OH, USA
- Center for Biobehavioral Health, Abigail Wexner Research Institute, Columbus, OH, USA
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Charlton BM, Reynolds CA, Tabaac AR, Godwin EG, Porsch LM, Agénor M, Grimstad FW, Katz-Wise SL. Unintended and teen pregnancy experiences of trans masculine people living in the United States. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2021; 22:65-76. [PMID: 34651143 PMCID: PMC8040679 DOI: 10.1080/26895269.2020.1824692] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Trans masculine people are more likely than cisgender peers to have a teen or unintended pregnancy, though little is known about the origins of these disparities. AIMS This study aimed to describe teen and unintended pregnancy experiences among trans masculine people in order to elucidate risk factors and pregnancy-related needs. METHODS As a part of the United States-based SexuaL Orientation, Gender Identity, and Pregnancy Experiences (SLOPE) study, in-depth, semi-structured interviews were conducted between March 2017 and August 2018 with 10 trans masculine people, ages 20-59 years, who experienced a teen or unintended pregnancy. Audio-recorded interviews were professionally transcribed, then analyzed using immersion/crystallization and thematic analysis approaches. The themes were contextualized using sociodemographic survey data. RESULTS The four themes that were developed from participants' narratives highlighted: 1) how trans masculine people navigated having a pregnant body (e.g., heightened gender dysphoria due to being pregnant); 2) the importance of the cultural environment in shaping experiences as a trans masculine pregnant person (e.g., pregnancy and gender-related job discrimination); 3) the development of the pregnancy over time (e.g., decision-making processes); and 4) how pregnancy (and gender identity) affected relationships with other people (e.g., adverse family of origin experiences). DISCUSSION This study identified a number of risk factors for teen and unintended pregnancies among trans masculine people including physical and sexual abuse as well as ineffective use of contraception. This research also identifies unique needs of this population, including: relieving gender dysphoria, combating discrimination, and ensuring people feel visible and welcome, particularly in reproductive healthcare spaces. Public health practitioners, healthcare providers, and support networks (e.g., chosen family) can be key sources of support. Attention to risk factors, unique needs, and sources of support will improve reproductive healthcare and pregnancy experiences for trans masculine people.
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Affiliation(s)
- Brittany M. Charlton
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Colleen A. Reynolds
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ariella R. Tabaac
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Eli G. Godwin
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Lauren M. Porsch
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Madina Agénor
- Department of Community Health, Tufts University, Medford, MA
- Department of Obstetrics and Gynecology, Tufts University School of Medicine, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Frances W. Grimstad
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, MA, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, Harvard Medical School, Boston, MA, USA
| | - Sabra L. Katz-Wise
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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Peri A, Ahler A, Gook D, O'Connell MA, Bourne H, Nightingale M, Telfer M, Jayasinghe Y, Pang KC. Predicting successful sperm retrieval in transfeminine adolescents after testicular biopsy. J Assist Reprod Genet 2021; 38:2735-2743. [PMID: 34424432 PMCID: PMC8581091 DOI: 10.1007/s10815-021-02293-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 08/03/2021] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Increasing numbers of transgender adolescents are receiving gender-affirming treatments (GAT). Given GAT can impair reproductive function, clinical guidelines advise prior counselling regarding fertility preservation (FP). For transgender adults assigned male at birth, FP is usually achieved via a masturbatory sample and sperm cryopreservation. This is less straightforward in transgender adolescents, since they may not be developmentally ready to masturbate and/or masturbation may cause unacceptable gender dysphoria. Testicular biopsy represents an alternative method for sperm retrieval in these adolescents, but for those in early/mid puberty, it is difficult to predict whether sperm will be found. The purpose of this study was therefore to identify factors that predict successful sperm retrieval for cryopreservation via testicular biopsy. METHODS A retrospective cohort study was undertaken at a tertiary-referral pediatric gender service. Subjects were included if they'd received a testicular biopsy in association with the commencement of GAT between 2010 and 2019. The primary outcome measure was successful sperm retrieval, and potential predictors included age, testicular volume and serum testosterone, LH and FSH levels. RESULTS Of 25 subjects who received a biopsy prior to starting any GAT, 17 had successful sperm retrieval. While age, testosterone, LH and FSH levels showed minimal differences, testicular volume was significantly higher in those with successful sperm retrieval, and a threshold of ≥ 10 mL showed 92% sensitivity and 71% specificity in predicting successful retrieval. An additional 6 patients received a biopsy after starting puberty suppression and before commencement of oestrogen, and one of these individuals had sperm successfully retrieved despite > 2 years of regular puberty suppression. CONCLUSION These findings suggest that testicular volume is most useful in predicting successful sperm retrieval following testicular biopsy in transgender adolescents and are likely to be of relevance to other young people undertaking FP, including those with cancer.
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Affiliation(s)
- Angus Peri
- Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Astrid Ahler
- Reproductive Medicine and Gynecological Endocrinology (RME), University Hospital Basel, Basel, Switzerland
| | - Debra Gook
- Department of Obstetrics & Gynaecology, University of Melbourne, Royal Women's Hospital, Parkville, VIC, Australia
- Reproductive Services/Melbourne IVF, Royal Women's Hospital, Parkville, VIC, Australia
| | - Michele A O'Connell
- Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Pediatrics, University of Melbourne, Parkville, VIC, Australia
- Royal Children's Hospital, Melbourne, VIC, Australia
| | - Harold Bourne
- Reproductive Services/Melbourne IVF, Royal Women's Hospital, Parkville, VIC, Australia
| | - Michael Nightingale
- Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Pediatrics, University of Melbourne, Parkville, VIC, Australia
- Royal Children's Hospital, Melbourne, VIC, Australia
| | - Michelle Telfer
- Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Pediatrics, University of Melbourne, Parkville, VIC, Australia
- Royal Children's Hospital, Melbourne, VIC, Australia
| | - Yasmin Jayasinghe
- Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Obstetrics & Gynaecology, University of Melbourne, Royal Women's Hospital, Parkville, VIC, Australia
- Royal Children's Hospital, Melbourne, VIC, Australia
| | - Ken C Pang
- Murdoch Children's Research Institute, Parkville, VIC, Australia.
- Department of Pediatrics, University of Melbourne, Parkville, VIC, Australia.
- Royal Children's Hospital, Melbourne, VIC, Australia.
- Inflammation Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia.
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Pirtea P, Ayoubi JM, Desmedt S, T’Sjoen G. Ovarian, breast, and metabolic changes induced by androgen treatment in transgender men. Fertil Steril 2021; 116:936-942. [DOI: 10.1016/j.fertnstert.2021.07.1206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 01/15/2023]
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Bonan S, Chapel-Lardic E, Rosenblum O, Dudkiewicz-Sibony C, Chamouard L, Wolf JP, Thiounn N, Condat A, Chalas C, Patrat C, Mendes N, Drouineaud V. Characteristics and intentions of heterosexual couples comprising a transgender man awaiting sperm donation to conceive a child. Andrology 2021; 9:1799-1807. [PMID: 34467677 DOI: 10.1111/andr.13103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 08/08/2021] [Accepted: 08/13/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND More than half of transgender (TG) men wish to have children. Until recently, TG people in France were rarely offered gamete donation, mainly because the Bioethics Law allows the use of assisted reproductive technologies (ART) only in infertile couples. The only option currently available for heterosexual couples with a TG man is ART with sperm donation. The Center for Study and Preservation of Eggs and Sperm (CECOS) of the Cochin Hospital is the first French center to propose sperm donation to such couples, and has done so since 1999. OBJECTIVES To determine the main characteristics and intentions of 43 couples, including a TG man and his cisgender female partner awaiting sperm donation. MATERIALS AND METHODS A retrospective analysis was carried out on the records from October 2010 to December 2019, of 43 couples with a TG man who applied for sperm donation at the CECOS of the Cochin Hospital (Paris, France). RESULTS The mean age of TG men and cisgender women was 32 ± 6.6 and 29.7 ± 4.6 years, respectively. In 77% of cases, the couple met before the man's transition. Eighty-one percent of the couples were in a stable relationship for at least 3 years, and 94% wished to have a child for no more than 5 years. Almost all of the couples (95%) intended to inform their child of their conception by sperm donation and the father's transidentity (92%). DISCUSSION Due to restrictive French legislation, the profile of our couples probably does not reflect that of all couples consisting of a TG man and a cisgender woman. The study took place over a long period of time and the characteristics of the couples could probably change over time. CONCLUSION The couples often met before the man's transition, cohabited for several years, intended to inform their child of sperm donation and the father's transidentity.
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Affiliation(s)
- Sarah Bonan
- Service de Biologie de la Reproduction - CECOS, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris (AP-HP) Centre, Université de Paris, Paris, France
| | - Emeline Chapel-Lardic
- Service de Biologie de la Reproduction - CECOS, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris (AP-HP) Centre, Université de Paris, Paris, France
| | - Ouriel Rosenblum
- Service de Biologie de la Reproduction - CECOS, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris (AP-HP) Centre, Université de Paris, Paris, France.,Service de Psychiatrie de l'enfant et de l'adolescent, Hôpital Universitaire La Pitié - Salpétrière, Assistance Publique - Hôpitaux de Paris (AP-HP), Sorbonne Université, Paris, France
| | - Charlotte Dudkiewicz-Sibony
- Service de Biologie de la Reproduction - CECOS, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris (AP-HP) Centre, Université de Paris, Paris, France
| | - Laura Chamouard
- Service de Biologie de la Reproduction - CECOS, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris (AP-HP) Centre, Université de Paris, Paris, France
| | - Jean-Philippe Wolf
- Service de Biologie de la Reproduction - CECOS, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris (AP-HP) Centre, Université de Paris, Paris, France.,Inserm U1016, Institut Cochin, Université de Paris, Paris, France
| | - Nicolas Thiounn
- Inserm U1016, Institut Cochin, Université de Paris, Paris, France.,Service d'Urologie, Centre Hospitalier Georges Pompidou, Assistance Publique - Hôpitaux de Paris (AP-HP) Centre, Université de Paris, Paris, France
| | - Agnès Condat
- Service de Psychiatrie de l'enfant et de l'adolescent, Hôpital Universitaire La Pitié - Salpétrière, Assistance Publique - Hôpitaux de Paris (AP-HP), Sorbonne Université, Paris, France
| | - Céline Chalas
- Service de Biologie de la Reproduction - CECOS, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris (AP-HP) Centre, Université de Paris, Paris, France
| | - Catherine Patrat
- Service de Biologie de la Reproduction - CECOS, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris (AP-HP) Centre, Université de Paris, Paris, France.,Inserm U1016, Institut Cochin, Université de Paris, Paris, France
| | - Nicolas Mendes
- Service de Psychiatrie de l'enfant et de l'adolescent, Hôpital Universitaire La Pitié - Salpétrière, Assistance Publique - Hôpitaux de Paris (AP-HP), Sorbonne Université, Paris, France
| | - Véronique Drouineaud
- Service de Biologie de la Reproduction - CECOS, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris (AP-HP) Centre, Université de Paris, Paris, France
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Breaking Down Barriers to Reproductive Care for Transgender People. AACE Clin Case Rep 2021; 8:96-98. [PMID: 35415232 PMCID: PMC8984180 DOI: 10.1016/j.aace.2021.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/02/2021] [Accepted: 08/16/2021] [Indexed: 12/03/2022] Open
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