ESPE Abstracts (2018) 89 P-P2-353

Young Transgender People's Attitudes to Fertility Preservation and Practice

Elena Monti, Sandra Walton-Betancourth, Raheala Wafa, Alice Roberts, Sara Kleczewski, Kirpal Adu-Gyamfi, Elaine Perkins, Elizabeth Williamson & Gary Butler


University College London Hospital, London, UK


Background: GnRH analogue and subsequent oestradiol treatments are indicated to alleviate gender dysphoriain adolescent male to female young people (MtF; transgirls). Side effects include impairments in gonadal histology that may cause infertility or biological sterility. Current guidelines encourage professionals to address potential infertility risk and fertility preservation options with transgender youth and their families before starting these treatments.

Purpose: The aim of this study was to examine fertility preservation uptake and rate of sperm banking success among transgirls seen in our paediatric endocrine clinic.

Methods: This is a retrospective study of young people with DSM IV codes for gender dysphoria attending the Gender Identity Development Service (GIDS) endocrine clinic. Between 2015 and 2017, 179 transgirls were referred to the GIDS endocrine clinic. Fertility counselling was documented. YP could also choose to opt for professional fertility clinic counselling.

Results: 60 MtF (34%) requested referral to our fertility laboratory. Mean age at referral was 16.4 (±1.9 years). 13 transgirls were younger than 15 years (13.4±0.8) and 47 were 15 years and older (17.2±0.9) (Table 1).

Table 1
<15 years n:13≥15 years n:47
Hormonal treatment status No treatment started9No treatment started31
Hormone Blocker-Hormone Blocker10
Cross sex hormones- Cross sex hormones1
No data 4No data 6
Fertility preservation counselling 11 (85%)36 (75%)
Fertility preservation uptake 10 (77%)28 (58%)
Age at sperm banking 13.4 years (±0.8 SD)17.2 years (±0.9 SD)
Mean number of visits (SD)1.9 (±1.1 SD)1.4 (±0.6 SD)
Future use of sample Unsure 10 (69%)Unsure 18 (38%)
Surrogacy/IVF/Partner1 (8%)Surrogacy/IVF/Partner15 (31%)
N/A 2N/A 15(31%)
Sperm banking in referredSuccessful 7 (54%) Successful 26 (54%)
Unsuccessful 2 (15%)Unsuccessful 7 (15%)
Declined2 (15%)Declined8 (17%)
Waiting list - Waiting list4 (8%)

Conclusions: Our cohort of transgirls had a good rate of sperm banking success, regardless of their age. Interestingly lack of clarity regarding the future use of sperm samples among young participants decreased as the group got older. If fertility preservation is handled sensitively in young transgirls, a high success rate can be obtained and should therefore be considered early in the transition process. Developmentally appropriate fertility counselling is essential in in this population. Guidelines and specific pathways are needed.

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