Fertility Preservation for Transgender Adolescents
TL;DR: In this paper, the authors describe fertility preservation (FP) utilization by transgender adolescents within a pediatric gender clinic between July 2013 and July 2016, using a retrospective chart review to abstract demographic and clinical information among adolescents initiating gender-affirming hormones, including patient age at initial FP consultation, birth-assigned sex, race/ethnicity, and outcome of FP consultation.
About: This article is published in Journal of Adolescent Health.The article was published on 2017-07-01 and is currently open access. It has received 177 citations till now. The article focuses on the topics: Transgender & Gender dysphoria.
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TL;DR: The SOC-8 guidelines are intended to be flexible to meet the diverse health care needs of TGD people globally and offer standards for promoting optimal health care and guidance for the treatment of people experiencing gender incongruence.
Abstract: Abstract Background: Transgender healthcare is a rapidly evolving interdisciplinary field. In the last decade, there has been an unprecedented increase in the number and visibility of transgender and gender diverse (TGD) people seeking support and gender-affirming medical treatment in parallel with a significant rise in the scientific literature in this area. The World Professional Association for Transgender Health (WPATH) is an international, multidisciplinary, professional association whose mission is to promote evidence-based care, education, research, public policy, and respect in transgender health. One of the main functions of WPATH is to promote the highest standards of health care for TGD people through the Standards of Care (SOC). The SOC was initially developed in 1979 and the last version (SOC-7) was published in 2012. In view of the increasing scientific evidence, WPATH commissioned a new version of the Standards of Care, the SOC-8. Aim: The overall goal of SOC-8 is to provide health care professionals (HCPs) with clinical guidance to assist TGD people in accessing safe and effective pathways to achieving lasting personal comfort with their gendered selves with the aim of optimizing their overall physical health, psychological well-being, and self-fulfillment. Methods: The SOC-8 is based on the best available science and expert professional consensus in transgender health. International professionals and stakeholders were selected to serve on the SOC-8 committee. Recommendation statements were developed based on data derived from independent systematic literature reviews, where available, background reviews and expert opinions. Grading of recommendations was based on the available evidence supporting interventions, a discussion of risks and harms, as well as the feasibility and acceptability within different contexts and country settings. Results: A total of 18 chapters were developed as part of the SOC-8. They contain recommendations for health care professionals who provide care and treatment for TGD people. Each of the recommendations is followed by explanatory text with relevant references. General areas related to transgender health are covered in the chapters Terminology, Global Applicability, Population Estimates, and Education. The chapters developed for the diverse population of TGD people include Assessment of Adults, Adolescents, Children, Nonbinary, Eunuchs, and Intersex Individuals, and people living in Institutional Environments. Finally, the chapters related to gender-affirming treatment are Hormone Therapy, Surgery and Postoperative Care, Voice and Communication, Primary Care, Reproductive Health, Sexual Health, and Mental Health. Conclusions: The SOC-8 guidelines are intended to be flexible to meet the diverse health care needs of TGD people globally. While adaptable, they offer standards for promoting optimal health care and guidance for the treatment of people experiencing gender incongruence. As in all previous versions of the SOC, the criteria set forth in this document for gender-affirming medical interventions are clinical guidelines; individual health care professionals and programs may modify these in consultation with the TGD person.
272 citations
TL;DR: For instance, this article found that 70.5% of TGNC adolescents were interested in adoption and 35.9% in biological parenthood; more gender-nonconforming adolescents than transgender youth expressed interest in biological fertility.
123 citations
TL;DR: Although a majority of transgender youth in this study were uninterested in using FP, extending exploration of this topic with young people may be useful given findings of their openness to the idea that fertility attitudes may change in adulthood.
91 citations
TL;DR: The findings indicate that fertility preservation should be made available as an option to all transgender or non-binary people prior to undertaking treatment which may impact on fertility, however, it should also be recognised that not all people who are transgender ornon-binary will want to undertake fertility preservation, and that notall people may be able to afford to.
Abstract: Historically, transitioning gender was seen as precluding transgender people from having children in the future. However, there are now increased reproductive options available to transgender people, with such options also available to non-binary people (i.e., people whose gender is not exclusively male or female). These options include undertaking fertility preservation if genetic children may be desired in the future. Despite these increased options, there is still only a limited amount of international research exploring the views of transgender and non-binary people on fertility preservation. This mixed-methods study draws on a convenience sample of Australian transgender and non-binary adults, focused on their decision making about fertility preservation. The questionnaire was constructed by the authors, drawing on previous research. Participants were recruited via Australian organisations and groups made up of and/or working with people who are transgender or non-binary. The questionnaire was open from January–February 2018. The final sample included 409 participants. Statistical analyses were conducted on the closed-ended responses. Open-ended responses were analysed via a conventional content analysis. Decisions about fertility preservation were influenced by views on the importance of genetic relatedness, willingness to delay transition, economic resources, already having children or desiring children in the future, and the views of significant others. Advice or counselling prior to decision making was received only by a minority of participants. Very few participants (7%) had undertaken fertility preservation, although 95% said that fertility preservation should be offered to all transgender and non-binary people. Participants who viewed genetic relatedness as important were more likely to have undertaken fertility preservation. The findings indicate that fertility preservation should be made available as an option to all transgender or non-binary people prior to undertaking treatment which may impact on fertility. However, it should also be recognised that not all people who are transgender or non-binary will want to undertake fertility preservation, and that not all people may be able to afford to.
88 citations
TL;DR: The findings may serve to reassure transgender patients and their care providers that outcomes can be excellent even if testosterone therapy has already been initiated and whether similar results can be achieved without stopping testosterone therapy.
83 citations
References
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TL;DR: This version of the SOC recognizes that treatment for gender dysphoria has become more individualized, and can be used to help patients consider the full range of health services open to them, in accordance with their clinical needs and goals for gender expression.
Abstract: The Standards of Care (SOC) for the Health of Transsexual, Transgender, and Gender Nonconforming People is a publication of the World Professional Association for Transgender Health (WPATH). The overall goal of the SOC is to provide clinical guidance for health professionals to assist transsexual, transgender, and gender nonconforming people with safe and effective pathways to achieving lasting personal comfort with their gendered selves, in order to maximize their overall health, psychological well-being, and self-fulfillment. This assistance may include primary care, gynecologic and urologic care, reproductive options, voice and communication therapy, mental health services (e.g., assessment, counseling, psychotherapy), and hormonal and surgical treatments. The SOC are based on the best available science and expert professional consensus. Because most of the research and experience in this field comes from a North American and Western European perspective, adaptations of the SOC to other parts ...
2,762 citations
TL;DR: Transgender men are achieving pregnancy after having socially, medically, or both transitioned and themes from this study can be used to develop transgender-appropriate services and interventions that may improve the health and health care experiences of transgender men.
393 citations
TL;DR: The data reveal that the majority of transsexual men desire to have children, and more attention should be paid to this topic during the diagnostic phase of transition and to the consequences for genetic parenthood after starting sex reassignment therapy.
Abstract: Background: Hormonal therapy and sex reassignment surgery (SRS) in transsexual persons lead to an irreversible loss of their reproductive potential. The current and future technologies could create the possibility for female-to-male transsexual persons (transsexual men) to have genetically related children. However, little is known about this topic. The aim of this study is to provide information on the reproductive wishes of transsexual men after SRS.
Methods: A self-constructed questionnaire was presented to 50 transsexual men in a single-center study.
Results: The majority (64%) of transsexual men were currently involved in a relationship. Eleven participants (22.0%) reported having children. For eight participants, their female partner was inseminated with donor sperm, whereas three participants gave birth before hormonal therapy and SRS. At the time of interview, more than half of the participants desired to have children (54%). There were 18 participants (37.5%) who reported that they had considered freezing their germ cells, if this technique would have been available previously. Participants without children at the time of investigation expressed this desire more often than participants with children (x2 test: P ¼ 0.006).
Conclusions: Our data reveal that the majority of transsexual men desire to have children. Therefore, more attention should be paid to this topic during the diagnostic phase of transition and to the consequences for genetic parenthood after starting sex reassignment therapy.
258 citations
TL;DR: More research is needed to understand parenthood goals among transgender youth at different ages and developmental stages and to explore the impact of gender dysphoria on decision-making about FP and parenthood.
206 citations
TL;DR: It is demonstrated that androgens alone may induce polycystic changes in women with transsexualism and the assumption that the role of androgens is pivotal at the follicular level—inducing follicle growth arrest and accelerating cystic changes—in the genesis ofpolycystic ovaries is reinforced.
Abstract: Descriptions of the effect of androgens on ovarian human tissues are exceptional. This opportunity was provided for us by 17 women with transsexualism--female to male transsexuals (TSX)--who had been given androgens for a mean period of 21 months before hystero-salpingo-oophorectomy took place. Twenty-nine ovaries from TSX and 14 control ovaries from 13 regularly cycling women were examined. As compared with controls, TSX ovaries were enlarged and displayed a two-fold increase in cystic follicles and a 3.5-fold increase in atretic follicles; the ovarian cortex was collagenized and three-times thicker. Theca interna hyperplasia and luteinization were uniformly observed in TSX cystic follicles. Stromal hyperplasia was a constant finding in TSX ovaries, accompanied by clusters of luteinized stromal cells in 12 cases. Eventually, these findings met the histological criteria for the diagnosis of polycystic ovaries. These observations demonstrate that androgens alone may induce polycystic changes. The assumption that the role of androgens is pivotal at the follicular level--inducing follicle growth arrest and accelerating cystic changes--in the genesis of polycystic ovaries is reinforced.
174 citations