Study highlights potential barriers to fertility preservation for transgender adolescents
Among transgender adolescent patients in an Australian study, 62% of those who were assigned male sex at birth elected to pursue fertility preservation before seeking hormonal intervention — a much higher proportion than what has been reported in similar North American studies, according to researchers.
Kenneth C. Pang, MBBS (Hons), BMedSc, PhD, team leader and clinical scientist at Murdoch Children’s Research Institute in Melbourne, Australia, and colleagues said the “most likely explanation” for the contrast is a difference in access to fertility preservation.
“Our findings suggest that there is a strong intrinsic desire to undertake fertility preservation among transgender adolescents assigned male at birth and highlight the importance of offering affordable fertility preservation to these young people,” Pang told Healio.
Pang noted three North American studies published since 2016 that found that less than 5% of transgender adolescents elected fertility preservation. Pang said the publicly funded pediatric gender clinic where the current research was conducted has readily available fertility services, and is without certain health care barriers experienced by patients in places where the other studies were conducted.
“We were interested to know whether the low rates of fertility preservation that had been recently observed in North America reflected an intrinsic lack of desire for fertility preservation among transgender adolescents or instead arose due to health care barriers, such as high cost and limited availability,” Pang said.
At the clinic where the research was conducted, patients who were assigned male sex at birth have a relatively affordable option if they want to undergo fertility preservation before receiving hormonal intervention. Semen analysis costs approximately $66, annual sperm storage costs $132 and testicular biopsies are free, according to the study.
Pang and colleagues conducted a retrospective review of patients with gender dysphoria who had received gonadotropin-releasing hormone agonists and/or gender-affirming hormones from Jan. 1, 2003, through June 1, 2017. Among 102 patients who elected to receive fertility counseling before taking hormones, 53 were assigned male sex at birth, whereas 49 were assigned female sex. The mean age of the patients was 15.6 years.
None of the patients who were assigned female sex at birth pursued fertility preservation. Sixteen of them gave no reason for their decision, whereas 33 said they would revisit the topic at an older age.
In comparison, 33 of the 53 (62%) patients assigned male sex at birth elected fertility preservation. Among them, 22 successfully froze sperm, whereas the other 11 underwent testicular biopsies.
“We hypothesized that rates of fertility preservation uptake within our clinical population would be higher than those previously reported and better reflect the intrinsic desire for fertility preservation among transgender adolescents,” Pang said. “Mind you, we didn’t necessarily think that the rates among transgender adolescents assigned male at birth would be that high.” – by Ken Downey Jr.
Disclosures: Pang reports receiving funding from the Royal Children’s Hospital Foundation. Please see the study for other authors’ financial disclosures.