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).
|<15 years n:13||≥15 years n:47|
|Hormonal treatment status||No treatment started||9||No treatment started||31|
|Hormone Blocker||-||Hormone Blocker||10|
|Cross sex hormones||-||Cross sex hormones||1|
|No data||4||No 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/Partner||1 (8%)||Surrogacy/IVF/Partner||15 (31%)|
|Sperm banking in referred||Successful||7 (54%)||Successful||26 (54%)|
|Unsuccessful||2 (15%)||Unsuccessful||7 (15%)|
|Declined||2 (15%)||Declined||8 (17%)|
|Waiting list||-||Waiting list||4 (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.
27 - 29 Sep 2018
European Society for Paediatric Endocrinology