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Fertility Preservation Outcomes in Adolescent and Young Adult Feminizing Transgender Patients.
Pediatrics 2019; 144(3)Ped

Abstract

BACKGROUND

Fertility preservation enables patients undergoing gonadotoxic therapies to retain the potential for biological children and now has broader implications in the care of transgender individuals. Multiple medical societies recommend counseling on fertility preservation before initiating therapy for gender dysphoria; however, outcome data pre- and posttreatment are limited in feminizing transgender adolescents and young adults.

METHODS

The University of Pittsburgh Institutional Research Board approved this study. Data were collected retrospectively on transgender patients seeking fertility preservation between 2015 and 2018, including age at initial consultation and semen analysis parameters.

RESULTS

Eleven feminizing transgender patients accepted a referral for fertility preservation during this time; consultation occurred at median age 19 (range 16-24 years). Ten patients attempted and completed at least 1 semen collection. Eight patients cryopreserved semen before initiating treatment. Of those patients, all exhibited low morphology with otherwise normal median semen analysis parameters. In 1 patient who discontinued leuprolide acetate to attempt fertility preservation, transient azoospermia of 5 months' duration was demonstrated with subsequent recovery of spermatogenesis. In a patient who had previously been treated with spironolactone and estradiol, semen analysis revealed persistent azoospermia for the 4 months leading up to orchiectomy after discontinuation of both medications.

CONCLUSIONS

Semen cryopreservation is a viable method of fertility preservation in adolescent and young adult transgender individuals and can be considered in patients who have already initiated therapy for gender dysphoria. Further research is needed to determine the optimal length of time these therapies should be discontinued to facilitate successful semen cryopreservation.

Authors+Show Affiliations

UPMC Magee-Womens Hospital, Pittsburgh, Pennsylvania.UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; and.UPMC Magee-Womens Hospital, Pittsburgh, Pennsylvania.UPMC Magee-Womens Hospital, Pittsburgh, Pennsylvania.UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; and.UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; and.Magee-Womens Research Institute and Foundation, Pittsburgh, Pennsylvania.Magee-Womens Research Institute and Foundation, Pittsburgh, Pennsylvania vallih2@mwri.magee.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31383814

Citation

Barnard, Emily P., et al. "Fertility Preservation Outcomes in Adolescent and Young Adult Feminizing Transgender Patients." Pediatrics, vol. 144, no. 3, 2019.
Barnard EP, Dhar CP, Rothenberg SS, et al. Fertility Preservation Outcomes in Adolescent and Young Adult Feminizing Transgender Patients. Pediatrics. 2019;144(3).
Barnard, E. P., Dhar, C. P., Rothenberg, S. S., Menke, M. N., Witchel, S. F., Montano, G. T., ... Valli-Pulaski, H. (2019). Fertility Preservation Outcomes in Adolescent and Young Adult Feminizing Transgender Patients. Pediatrics, 144(3), doi:10.1542/peds.2018-3943.
Barnard EP, et al. Fertility Preservation Outcomes in Adolescent and Young Adult Feminizing Transgender Patients. Pediatrics. 2019;144(3) PubMed PMID: 31383814.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Fertility Preservation Outcomes in Adolescent and Young Adult Feminizing Transgender Patients. AU - Barnard,Emily P, AU - Dhar,Cherie Priya, AU - Rothenberg,Stephanie S, AU - Menke,Marie N, AU - Witchel,Selma F, AU - Montano,Gerald T, AU - Orwig,Kyle E, AU - Valli-Pulaski,Hanna, Y1 - 2019/08/05/ PY - 2019/04/30/accepted PY - 2019/8/7/pubmed PY - 2019/8/7/medline PY - 2019/8/7/entrez JF - Pediatrics JO - Pediatrics VL - 144 IS - 3 N2 - BACKGROUND: Fertility preservation enables patients undergoing gonadotoxic therapies to retain the potential for biological children and now has broader implications in the care of transgender individuals. Multiple medical societies recommend counseling on fertility preservation before initiating therapy for gender dysphoria; however, outcome data pre- and posttreatment are limited in feminizing transgender adolescents and young adults. METHODS: The University of Pittsburgh Institutional Research Board approved this study. Data were collected retrospectively on transgender patients seeking fertility preservation between 2015 and 2018, including age at initial consultation and semen analysis parameters. RESULTS: Eleven feminizing transgender patients accepted a referral for fertility preservation during this time; consultation occurred at median age 19 (range 16-24 years). Ten patients attempted and completed at least 1 semen collection. Eight patients cryopreserved semen before initiating treatment. Of those patients, all exhibited low morphology with otherwise normal median semen analysis parameters. In 1 patient who discontinued leuprolide acetate to attempt fertility preservation, transient azoospermia of 5 months' duration was demonstrated with subsequent recovery of spermatogenesis. In a patient who had previously been treated with spironolactone and estradiol, semen analysis revealed persistent azoospermia for the 4 months leading up to orchiectomy after discontinuation of both medications. CONCLUSIONS: Semen cryopreservation is a viable method of fertility preservation in adolescent and young adult transgender individuals and can be considered in patients who have already initiated therapy for gender dysphoria. Further research is needed to determine the optimal length of time these therapies should be discontinued to facilitate successful semen cryopreservation. SN - 1098-4275 UR - https://www.unboundmedicine.com/medline/citation/31383814/Fertility_Preservation_Outcomes_in_Adolescent_and_Young_Adult_Feminizing_Transgender_Patients L2 - http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&pmid=31383814 DB - PRIME DP - Unbound Medicine ER -