Desire for children and fertility preservation in transgender and gender-diverse people: A systematic review

Stolk, T.H.R.; Asseler, Joyce D.; Huirne, Judith A.F.; Boogaard, E. van den; Mello, Norah M. van

doi:10.1016/j.bpobgyn.2023.102312

Cited by 21 publications

(17 citation statements)

References 105 publications

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“…Fertility preservation rates were very low, with only six individuals undergoing cryopreservation, corresponding to five of the 42 AMAB individuals (11%) and one of the 121 AFAB individual receiving GAMT (0.8%). Low fertility preservation rates are also described in other studies ( 45 – 47 ), which are discordant with the reported desire for biological children in TGD individuals ( 24 ). Fertility preservation and possible effects of gender-affirming treatment on fertility are discussed routinely prior to any treatment start as part of the consent discussion, but Vienna University Hospital currently does not offer specialized fertility consultations for transgender adolescents.…”

Section: Discussionsupporting

confidence: 77%

“…However, even centers offering specialized consultations still had similarly low fertility preservation rates ( 47 ). When considering these low rates, multiple factors should be considered: while the majority of TGD adolescents express a desire for future children (48.7%–67%), only a fraction is interested in having biological children (9%-35%) and most are interested in adoption (70-80%) ( 24 ). However, in an Australian Study investigating TGD parenthood, most had become parents via their partner giving birth (64%), 28% had given birth themselves, and only 5% and 3% were step- or foster parents respectively ( 48 ).…”

Section: Discussionmentioning

confidence: 99%

“…However, in an Australian Study investigating TGD parenthood, most had become parents via their partner giving birth (64%), 28% had given birth themselves, and only 5% and 3% were step- or foster parents respectively ( 48 ). To fulfill their desire for children, most TGD people have to overcome many barriers, even more so when pursuing biological offspring ( 24 ). More emphasis should be placed on improved access to fertility counseling and fertility preservation.…”

Section: Discussionmentioning

confidence: 99%

“…This creates an immense financial barrier for fertility treatment and should be addressed at a policy level to provide best possible care for all transgender children and adolescents. Insurance coverage of fertility preservation related costs might also increase fertility preservation utilization ( 24 ).…”

Section: Discussionmentioning

confidence: 99%

“…This has been shown to improve psychological well-being ( 19 ), psychosocial functioning ( 20 ), mental health outcomes ( 21 , 22 ) and body satisfaction ( 23 ) in TGD adolescents. However, GAHT negatively impacts fertility ( 24 ) and potential adverse effects of long-term GAHT are not yet fully researched yet ( 25 , 26 ).…”

Section: Introductionmentioning

confidence: 99%

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Treatment trajectories of gender incongruent Austrian youth seeking gender-affirming hormone therapy

Steininger,

Knaus,

Kaufmann

et al. 2024

Front. Endocrinol.

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ObjectiveThe aim of this study was to describe the treatment trajectories of Austrian children and adolescents with gender incongruence seeking gender-affirming medical care.MethodsPatients who presented with gender incongruence at the pediatric outpatient clinic for differences in sex development at a large university hospital in Austria from January 2008 to December 2022 were included in a retrospective chart review, and analyzed regarding referral numbers, patient characteristics, treatment trajectories, fertility preservation, and legal gender marker changes.ResultsOf 310 eligible patients, 230 (74.2%) were assigned female at birth (AFAB), and 80 (25.8%) were assigned male at birth (AMAB). The number of referrals increased steeply from 2008 to 2018, whereafter it stabilized at around 50 per year. At the time of initial presentation, the median age of patients was 15.6 years (IQR 14.3-16.8). AMAB individuals tended to be younger (median 14.9 years, IQR 13.9-16.8) than AFAB individuals (median 15.8 years, IQR 14.4-16.8; p= 0.012). 207 (66,8%) completed the assessment process and were eligible for gender affirming medical treatment (GAMT). Of those, 89% (186/207) commenced gender affirming hormone therapy in the pediatric outpatient clinic (79/186 received GnRHa monotherapy, 91/186 GnRHa and sex steroids, and 16/186 sex steroid monotherapy). Of the 54 AMAB individuals receiving GAMT, 6 (11.1%) completed fertility preservation prior to therapy initiation. Only 1/132 AFAB adolescents receiving GAMT completed fertility preservation. Chest masculinization surgery was performed in 22 cases (16.7%), and breast augmentation in two cases (3.7%) between the ages of 16 and 18. Changes in legal gender marker were common, with 205 individuals (66.1%) having changed their legal gender marker.ConclusionThis is the first time that treatment trajectories, fertility preservation rates, and changes of legal gender marker have been described in Austrian adolescents with gender incongruence seeking GAMT. The majority received GAMT and changed their legal gender marker, while gender affirming surgery rates were low, and utilization of fertility preservation treatment options was rare.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Treatment trajectories of gender incongruent Austrian youth seeking gender-affirming hormone therapy

Steininger,

Knaus,

Kaufmann

et al. 2024

Front. Endocrinol.

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What Is the Aim of Pediatric “Gender‐Affirming” Care?

Gorin

2024

Hastings Center Report

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The original “Dutch Protocol”—the treatment model comprised of puberty blockers, cross‐sex hormones, and surgery—was intended to improve the mental and physical health of pediatric patients experiencing distress over their sexed bodies. Consequently, both researchers and clinicians have couched eligibility for treatment and measures of treatment efficacy in terms of the interventions’ effects on outcomes such as gender dysphoria, depression, anxiety, and suicide. However, recent systematic reviews have concluded that the scientific evidence supporting these interventions is uncertain, leading to significant international differences in what treatments are offered to youth. Against this backdrop, a different argumentative approach has emerged in support of gender‐affirming care. This approach appeals not to reductions in patient morbidity or mortality but to patient autonomy, where medical intervention is pursued as a means to the satisfaction of a patient's “embodiment goals.” In this article, I raise objections to autonomy‐based justifications for pediatric gender‐affirming care, concluding that these arguments misunderstand the place of autonomy in clinical decision‐making and, consequently, put patients at risk of medical harm.

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Transgender and gender diverse individuals' perspectives on discussions of fetal sex chromosomes in obstetrics care

Tyrie,

Oliva,

Llorin

et al. 2024

Journal of Genetic Counseling

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In the past decade, prenatal cell‐free DNA screening (cfDNA) has become ubiquitous as a screening tool for fetal aneuploidy and sex chromosomes. Healthcare provider (HCP) discussions and public perceptions of sex and gender uniquely impact transgender and gender diverse (TGD) individuals, and existing cfDNA guidelines lack recommendations regarding how to discuss sex and gender prenatally. The aim of this exploratory qualitative study was to examine TGD individuals' opinions regarding fetal sex chromosome disclosure sessions. Twelve semi‐structured virtual interviews were conducted with TGD individuals regarding their perspectives on the discussion of fetal sex chromosomes by HCPs within the prenatal setting. Interviews were coded and analyzed using a reflexive thematic approach, generating four major themes: (1) Current practices in prenatal care exclude gender diverse people; (2) HCPs' responsibility to de‐gender discussions of sex chromosomes in prenatal care; (3) HCPs' responsibility to acknowledge gender diversity; and (4) HCPs' influence on societal perceptions of sex and gender. More guidance is needed from professional societies regarding best practices for HCP discussions of sex chromosomes, sex, and gender. Participants recommended HCPs educate patients about sex chromosomes and their relevance to health while avoiding the conflation of sex and gender terms. Additionally, there is an acute need for trans‐inclusive prenatal healthcare. Ultimately, HCPs' and organizations are in a prime position to deconstruct rigid gender binaries and promote societal inclusion of TGD people.

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Desire for children and fertility preservation in transgender and gender-diverse people: A systematic review

Cited by 21 publications

References 105 publications

Treatment trajectories of gender incongruent Austrian youth seeking gender-affirming hormone therapy

Treatment trajectories of gender incongruent Austrian youth seeking gender-affirming hormone therapy

What Is the Aim of Pediatric “Gender‐Affirming” Care?

Transgender and gender diverse individuals' perspectives on discussions of fetal sex chromosomes in obstetrics care

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