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Fertility concerns of the transgender patient.
Transl Androl Urol 2019; 8(3):209-218TA

Abstract

Transgender individuals who undergo gender-affirming medical or surgical therapies are at risk for infertility. Suppression of puberty with gonadotropin-releasing hormone agonist analogs (GnRHa) in the pediatric transgender patient can pause the maturation of germ cells, and thus, affect fertility potential. Testosterone therapy in transgender men can suppress ovulation and alter ovarian histology, while estrogen therapy in transgender women can lead to impaired spermatogenesis and testicular atrophy. The effect of hormone therapy on fertility is potentially reversible, but the extent is unclear. Gender-affirming surgery (GAS) that includes hysterectomy and oophorectomy in transmen or orchiectomy in transwomen results in permanent sterility. It is recommended that clinicians counsel transgender patients on fertility preservation (FP) options prior to initiation of gender-affirming therapy. Transmen can choose to undergo cryopreservation of oocytes or embryos, which requires hormonal stimulation for egg retrieval. Uterus preservation allows transmen to gestate if desired. For transwomen, the option for FP is cryopreservation of sperm either through masturbation or testicular sperm extraction. Experimental and future options may include cryopreservation and in vitro maturation of ovarian or testicular tissue, which could provide prepubertal transgender youth an option for FP since they lack mature gametes. Successful uterus transplantation with subsequent live birth is a new medical breakthrough for cisgender women with uterus factor infertility. Although it has not yet been performed in transgender women, uterus transplantation is a potential solution for those who wish to get pregnant. The transgender population faces many barriers to care, such as provider discrimination, lack of information, legal barriers, scarcity of fertility centers, financial burden, and emotional cost. Further research is necessary to investigate the feasibility of experimental FP options, provide better evidence-based information to clinicians and transgender patients alike, and to improve access to and quality of reproductive services for the transgender population.

Authors+Show Affiliations

Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA.Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA.Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA.Division of Plastic Surgery, Department of Surgery, University of Utah, Salt Lake City, UT, USA.Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA. Department of Obstetrics & Gynecology, University of Utah, Salt Lake City, UT, USA.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

31380227

Citation

Cheng, Philip J., et al. "Fertility Concerns of the Transgender Patient." Translational Andrology and Urology, vol. 8, no. 3, 2019, pp. 209-218.
Cheng PJ, Pastuszak AW, Myers JB, et al. Fertility concerns of the transgender patient. Transl Androl Urol. 2019;8(3):209-218.
Cheng, P. J., Pastuszak, A. W., Myers, J. B., Goodwin, I. A., & Hotaling, J. M. (2019). Fertility concerns of the transgender patient. Translational Andrology and Urology, 8(3), pp. 209-218. doi:10.21037/tau.2019.05.09.
Cheng PJ, et al. Fertility Concerns of the Transgender Patient. Transl Androl Urol. 2019;8(3):209-218. PubMed PMID: 31380227.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Fertility concerns of the transgender patient. AU - Cheng,Philip J, AU - Pastuszak,Alexander W, AU - Myers,Jeremy B, AU - Goodwin,Isak A, AU - Hotaling,James M, PY - 2019/8/6/entrez PY - 2019/8/6/pubmed PY - 2019/8/6/medline KW - Cryopreservation KW - fertility KW - transgender KW - uterus transplantation SP - 209 EP - 218 JF - Translational andrology and urology JO - Transl Androl Urol VL - 8 IS - 3 N2 - Transgender individuals who undergo gender-affirming medical or surgical therapies are at risk for infertility. Suppression of puberty with gonadotropin-releasing hormone agonist analogs (GnRHa) in the pediatric transgender patient can pause the maturation of germ cells, and thus, affect fertility potential. Testosterone therapy in transgender men can suppress ovulation and alter ovarian histology, while estrogen therapy in transgender women can lead to impaired spermatogenesis and testicular atrophy. The effect of hormone therapy on fertility is potentially reversible, but the extent is unclear. Gender-affirming surgery (GAS) that includes hysterectomy and oophorectomy in transmen or orchiectomy in transwomen results in permanent sterility. It is recommended that clinicians counsel transgender patients on fertility preservation (FP) options prior to initiation of gender-affirming therapy. Transmen can choose to undergo cryopreservation of oocytes or embryos, which requires hormonal stimulation for egg retrieval. Uterus preservation allows transmen to gestate if desired. For transwomen, the option for FP is cryopreservation of sperm either through masturbation or testicular sperm extraction. Experimental and future options may include cryopreservation and in vitro maturation of ovarian or testicular tissue, which could provide prepubertal transgender youth an option for FP since they lack mature gametes. Successful uterus transplantation with subsequent live birth is a new medical breakthrough for cisgender women with uterus factor infertility. Although it has not yet been performed in transgender women, uterus transplantation is a potential solution for those who wish to get pregnant. The transgender population faces many barriers to care, such as provider discrimination, lack of information, legal barriers, scarcity of fertility centers, financial burden, and emotional cost. Further research is necessary to investigate the feasibility of experimental FP options, provide better evidence-based information to clinicians and transgender patients alike, and to improve access to and quality of reproductive services for the transgender population. SN - 2223-4691 UR - https://www.unboundmedicine.com/medline/citation/31380227/Fertility_concerns_of_the_transgender_patient_ L2 - https://doi.org/10.21037/tau.2019.05.09 DB - PRIME DP - Unbound Medicine ER -