Most transgender and gender-nonconforming adolescents do not consider fertility preservation an important reason to delay the start of hormone therapy, but some cite parental attitudes regarding biological offspring as influencing any decision regarding treatment, according to survey data presented at the Pediatric Academic Societies Meeting.
“While hormone therapy has drastically improved the lives of countless transgender and gender-nonconforming youth, its impact on fertility can unfairly force individuals to decide at a very early age whether or not they should preserve the ability to be a biological parent one day,” Rebecca Persky, MD, a pediatric endocrinology fellow at the Eunice Kennedy Shriver National Institute of Child Health and Human Development, said in a press release. “These are difficult conversations for physicians to have with youth and families, and we hope our findings on how adolescents and parents approach these decisions will ultimately help providers counsel patients on hormone therapy with their fertility desires in mind.”
Persky and colleagues analyzed data from 66 transgender and gender-nonconforming adolescents (mean age, 16 years; 63% assigned female at birth) and 52 parents (mean age, 48 years) obtaining care at a hospital-based pediatric clinic for transgender youths in 2017. Parents and adolescents completed a 36-item electronic questionnaire regarding knowledge of fertility preservation, desire to have biological children and other factors that may influence their decision to pursue fertility preservation procedures. Researchers used logistic regression analysis to examine the association between willingness to delay HT to preserve fertility, desire to have biological children and demographic factors.
Within the cohort, 20% of adolescents and 11.5% of parents reported that it was important to have biological offspring, according to researchers. For adolescents, the importance of having biological children was associated with perceiving such a decision as important to their parents (OR = 6.07; 95% CI, 1.28-28.7). Only 4.5% of adolescents said they would be willing to delay the start of HT to undergo fertility preservation, with those teens citing the importance of having biological children as the most important factor (OR = 6.76; 95% CI, 6.53-6.99).
For parents, a lack of information about whether HT prevents biological fertility was associated with parent willingness to delay treatment for fertility preservation (OR = 24.57; 95% CI, 3.9-154.15), according to the researchers. Among teens, 70% agreed that discomfort with a part of the body they do not identify with was a factor influencing their decision to undergo fertility preservation.
The researchers noted that religious, financial, ethical and demographic factors were not associated with a willingness to delay HT.
“While the majority of transgender youth and their parents did not find it important to have biologic offspring and would not be willing to delay starting hormone therapy to pursue [fertility preservation], parental concern about uncertainty of effect on biologic fertility was associated with willingness to delay treatment,” the researchers wrote in the abstract. “More qualitative research is needed to understand youth and parent decisions regarding [fertility preservation].” – by Regina Schaffer
Persky R, et al. Attitudes towards fertility preservation among transgender youth and their parents. Presented at: Pediatric Academic Societies Meeting; May 5-8, 2018; Toronto.
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