Introduction: 1.4 million U.S. adults identify as transgender. Attitudes and knowledge about fertility preservation among transgender women (male sex at birth, but the gender identify is woman) have not been rigorously studied. Moreover, it is not clear to what extent healthcare providers follow recommendations from the World Professional Association for Transgender Health (WPATH) to discuss fertility preservation prior to initiation of gender affirming hormonal or surgical therapies that can permanently impact fertility. The objectives of the current study were to describe attitudes towards fertility amongst transgender women, and to explore the extent to which fertility preservation was offered to these patients in their clinical care.
Methods: A non-randomized survey about fertility and clinical experiences with fertility preservation was developed and distributed to transgender women participating at the Columbia University site of Project AFFIRM, an NIH funded multi-institutional study of transgender identity and health in the U.S. When applicable, data was supplemented with patient interviews. Data were analyzed with descriptive statistics.
Results: There were 133 participants in this study, average age 34.5 ± 13.6. 37.1% of patients reported a desire to have children in the future, with 15.9% expressing they would possibly like to have children in the future. 21.4% stated it was very important for them to have biological children. 78% of patients were taking gender-affirming hormonal therapy at the time of the survey. 81% of respondents had not taken steps to preserve their fertility. Only 16.5% of transgender women had seen a provider for issues pertaining to reproductive health. Of those who had seen someone, only 6 had been evaluated by a urologist (4.5%). 61% of patients stated that no health care provider discussed sperm banking prior to gender affirming hormone therapy or surgery. 5.5% (7) of patients had undergone sperm retrieval surgery for banking.
Conclusions: This is the first large-scale study examining attitudes towards fertility and clinical practices pertaining to fertility preservation in transgender women. 53% of transgender women indicated that they were definitely or possibly interested in having children, but 61% reported that they had not been offered fertility preservation prior to initiation of gender affirming hormonal or surgical therapies. Efforts to educate providers and patients about fertility preservation in this population could address this clear and important gap in clinical care. Source of
