Effective fertility counselling for transgender adolescents: a qualitative study of clinician attitudes and practices

Abstract

ObjectiveFertility counselling for trans and gender diverse (TGD) adolescents has many complexities, but there is currently little guidance for clinicians working in this area. This study aimed to identify effective strategies for—and qualities of—fertility counselling for TGD adolescents based on clinicians’ experiences.DesignWe conducted qualitative semi-structured individual interviews in 2019 which explored clinician experiences and fertility counselling practices, perspectives of the young person’s experience and barriers and facilitators to fertility preservation access. Data were analysed using thematic analysis.SettingThis qualitative study examined experiences of clinicians at the Royal Children’s Hospital—a tertiary, hospital-based, referral centre and the main provider of paediatric TGD healthcare in Victoria, Australia.ParticipantsWe interviewed 12 clinicians from a range of disciplines (paediatrics, psychology, psychiatry and gynaecology), all of whom were involved with fertility counselling for TGD adolescents.ResultsBased on clinician experiences, we identified five elements that can contribute to an effective approach for fertility counselling for TGD adolescents: a multidisciplinary team approach; shared decision-making between adolescents, their parents and clinicians; specific efforts to facilitate patient engagement; flexible personalised care; and reflective practice.ConclusionsIdentification of these different elements can inform and hopefully improve future fertility counselling practices for TGD adolescents, but further studies examining TGD adolescents’ experiences of fertility counselling are also required.

Fertility preservation in transgender men and the need for uniform, comprehensive counseling

“…Before FP counseling, a proper environment must be ascertained. This includes creating a welcoming office environment, providing gender-neutral bathrooms, having proper pronouns on forms, and using gender-neutral connotations when engaging in discussions ( 7 ). The American College of Obstetrics and Gynecology (ACOG) Committee’s opinion on this topic emphasizes creating an inclusive environment that helps reduce inequalities in care delivery to the transgender community ( 8 ).…”

“…The ASRM and ESHRE guidelines emphasize the importance of a multidisciplinary approach to FP counseling in transgender patients ( 1 , 15 ). A survey of pediatricians, mental health, and obstetricians identified the following key elements for effective counseling in transgender adolescents: multidisciplinary approach; shared decision making, individualized approaches; and reflective practices from clinicians ( 7 ). A multidisciplinary team includes, but is not limited to, obstetricians, specialists in transgender medicine, reproductive endocrinologists, infertility specialists, mental health professionals, and financial advisors ( 15 ).…”

“…A multidisciplinary team includes, but is not limited to, obstetricians, specialists in transgender medicine, reproductive endocrinologists, infertility specialists, mental health professionals, and financial advisors ( 15 ). This approach appears beneficial as it facilitates spreading information over multiple sessions, builds a community of support, and encourages communication ( 7 , 18 , 22 ). The authors also encourage clinicians to practice reflective practices, which they describe as being mindful of internal biases and cultural settings.…”

“…The authors also encourage clinicians to practice reflective practices, which they describe as being mindful of internal biases and cultural settings. ( 7 ). Given the challenging nature of counseling, reflective practices assist providers in being mindful of their own intrinsic biases.…”

“…A significant barrier to FP relates to the cost of treatments ( 5 , 6 , 7 , 8 , 13 , 20 , 23 ). Although the cost of ART is a barrier to many, regardless of gender identity, in the U.S., many transgender patients are uninsured or underinsured for gender-affirming treatments ( 6 , 13 ).…”