Desire to Have Children Among Transgender People in Germany: A Cross-Sectional Multi-Center Study

Abstract

Background Many trans individuals undergo medical interventions that result in irreversible loss of fertility. Little is known about their desire to have children and attitudes toward fertility preservation options. Aim To study how the desire for children and the use of fertility preservation options varies among trans women and trans men in different transitioning stages in Germany. Methods In this cross-sectional multi-center study, N = 99 trans women and N = 90 trans men were included. Of these, 26 of each sex were just about to start medical treatment. Outcomes Outcome parameter were the prevalence and determinants of a desire to have children in trans persons. Results Before treatment, a desire for children was significantly higher in trans men compared to trans women (P = .016). In contrast, in those who had already started treatment, a current desire to have children was equally present in about one fourth of participants of both genders while the interest in having children in the future was significantly higher in trans women (69.9%) than in trans men (46.9%; P = .034). Although 76.1% of trans women and 76.6% of trans men indicated that they had at least thought about preserving germ cells before starting medical transition, only 9.6% of trans women and 3.1% of trans men had put this idea into practice. Most trans men in both groups indicated that insemination of a female partner with sperm from an unrelated donor was a suitable option to fulfill their child wish, potentially explaining their low interest in preserving their own germ cells. Finally, a logistic regression analysis accounting for potential confounders revealed that overall trans women were more than twice as likely to have a current desire to have children (odds ratio 2.58), and this wish was on average 5.3% lower with each year of increasing age. Clinical Translation A low level of fertility preservation among trans persons is contrasted by a high level of desire for children. This highlights the importance of counseling trans individuals regarding fertility preservation options. Conclusions To our knowledge, this is the first study that addresses desire to have children in a clinical sample of trans women. It is also the first that investigates this issue among trans men who have not started medical treatment, and the first comparison of both genders. A limitation for the generalization of our results is the special legal context in Germany that forbids oocyte donation for reciprocal in vitro fertilization. Reproductive desire is high among trans individuals, but the use of reproductive options is surprisingly low.

Increasing normality–persisting barriers: Current socio‐demographic characteristics of 350 individuals diagnosed with gender dysphoria

“…vs 10.9%). 17 Notably, the proportion of individuals with genetical-related children in this study is two to five times higher compared with our cohort. We explain these differences with the higher median age of the study cohort (median age transwomen 41 years vs 25 years in our cohort, median age transmen 33 years vs 21 years in our cohort).…”

Gender Dysphoria disrupting the course of treatment of a recurrent Juvenile Granulosa Cell Tumor in an adolescent female - a case report.

“…The patient insisted on her arguments, and the parents wanted her to choose, but only after coming of age. After a fertility sparing operation, she may undergo surgical sex-change procedures in the future and, additionally, fertility preservation procedures [6,9,18]. There would be no such possibility after radical surgery.…”

A Qualitative Study Examining Transgender People’s Attitudes Toward The Desire to Have Biological Children and Pursue Fertility Treatments in Greece

“…Prior studies suggest that reproductive desire is as high among transgender people as it is in the general population [23,28,33]. However, among transgender adolescents, utilization rates of fertility preservation and reproductive options are presently impressively low [9,34] though steadily rising [10,23]. In 2012 it was argued that 'research on transgender adults suggests that about half desire biological children…, and over a third would have considered FP had such technologies been available at the time of their transition' [23].…”

“…In our small sample this percentage was much greater. Lack of adequate FP counseling may partly explain these low rates [9].…”

“…However, 'the uptake of this option to date has been low' [7] and very little is known 'about how transgender people create their families and the issues involved in these decisions' [8]. More speci cally, 'little is known about their desire to have children and attitudes toward fertility preservation options' [9]. As yet so little is known about the complex topic 'medically assisted reproduction in transgenders', and hence, it needs some more clari cation [10].…”