Perspectives on fertility preservation and parenthood among transgender youth and their parents

Abstract

ObjectiveThe aim of this study was to investigate the views of young people (YP) with gender dysphoria and their parents concerning fertility preservation and reproductive and life priorities.DesignA cross-sectional questionnaire-based study assessed knowledge of potential effects of treatments for gender dysphoria on fertility, current and future life priorities and preferences regarding future fertility/parenting options among YP and parents.ResultsA total of 79 YP (81% assigned female at birth [AFAB], 19% assigned male at birth [AMAB], aged 12–18 years, 68% between ages 16 years and 18 years) and 73 parents participated. The top current life priority for YP among eight options was being in good health; the least important priority was having children. Anticipated life priorities 10 years from now were ranked similarly. Parents’ rankings paralleled the YP responses; however, parents ranked having children as a significantly higher priority for AFAB compared with AMAB YP in 10 years. The majority of YP (66% AFAB, 67% AMAB) want to be a parent in the future. However, most do not envision having a biological child. A large majority (72% AFAB, 80% AMAB) were open to adoption. None of the YP surveyed pursued fertility preservation.ConclusionFertility is a low current and future life priority for transgender YP. The majority of YP wish to become parents but are open to alternative strategies for building a family. These data may explain in part the reported low rates of fertility preservation among this population. Further studies are needed to assess if life priorities change over time.

A qualitative study examining transgender people’s attitudes towards having biological children and pursuing fertility treatments in Greece

“…De Sutter et al (2002) found that while the vast majority of respondents thought that FP should be offered to transgender women, 90% of respondents believed that the loss of fertility was not a strong reason to delay the transition [53]. This is consistent with the statement of Chiniara et al (2019) presented below in footnote [54].…”

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

“…De Sutter et al (2002) found that while the vast majority of respondents were of the belief that fertility preservation should be offered to transgender women, 90% of respondents were of the belief that loss of fertility was not a strong reason to delay their transition [33]. This is in consistency with the aforementioned statement of Chiniara et al (2019) [37].…”

“…Persky et al (2020) found that the majority of transgender youth were not willing to delay their hormonal transition for fertility preservation as they 'did not nd having biological offspring important' [36]. Chiniara et al (2019) arguably hypothesized that fertility may be a low life-priority for young transgender people. 'The majority wish to become parents but are open to alternative strategies for building a family' [37].…”

“…Chiniara et al (2019) arguably hypothesized that fertility may be a low life-priority for young transgender people. 'The majority wish to become parents but are open to alternative strategies for building a family' [37]. However, under the rstorder desire to remain childless there may be the second-order desire to not delay gender transition Participants T1, T5 and T6 were of the opinion that delaying gender transition to facilitate fertility preservation could have negative impact on gender dysphoria and hence it could be distressing.…”

GnRHa (‘Puberty Blockers’) and Cross Sex Hormones for Children and Adolescents: Informed Consent, Personhood and Freedom of Expression

“…There is a clear difference between children and adolescents believing that hormones and surgery will make them the opposite sex and them believing that although their sex will not change, hormones and surgeries might enable them to 'pass' as the opposite sex. If a young female patient believes that testosterone and surgery will enable her to produce sperm and impregnate a woman (Chiniara et al 2019) then she is mistaken and so a naïve gender affirmation policy in clinics would risk that patient being misled. Moreover, the feeling of being an imposter may emerge or remain: 'passing' has been reported to bring its own problems (Mccann 2017, Switz 2019.…”