Hanya 2 dari 73 Remaja Klinik Gender yang Mencoba Pelestarian Kesuburan Meski Konseling Hampir Universal

Rendahnya pemanfaatan pelestarian kesuburan di kalangan anak muda transgender

Studi kohort & registri Pemblokir pubertas Etika medis & persetujuan

Authors: Leena Nahata, Amy C. Tishelman, Nicole M. Caltabellotta, Gwendolyn P. Quinn
Journal: Journal of Adolescent Health
Year: 2017
Source: https://doi.org/10.1016/j.jadohealth.2016.12.012

Summary

Researchers looked at the medical records of 73 teenagers with gender dysphoria (distress about their sex) who were being considered for puberty blockers or cross-sex hormones at an Ohio children's hospital. Almost all (72) had a recorded conversation about the risk that treatment could harm their future fertility, but only two tried to freeze eggs or sperm. Many said they would adopt (45%) or had never wanted children (21%). The authors call this use of fertility preservation low and say more research is needed on how teens' wishes about parenthood develop. The study is an early, often-cited sign that counselling alone rarely leads teens to save eggs or sperm. But it is small, relies on clinicians' notes, did not measure understanding or obstacles, and did not follow teens into adulthood to see if their views or regrets changed.

Key findings

Studi ini meninjau catatan 78 anak muda yang dirujuk untuk perawatan hormon di satu klinik gender anak AS dari Januari 2014 hingga Agustus 2016; 73 remaja yang telah memulai pubertas disertakan.
Sebanyak 72 dari 73 remaja (99%) memiliki pembicaraan yang tercatat tentang kesuburan sebelum memulai penghambat pubertas atau hormon lintas-seks.
Hanya 2 dari 73 remaja (3%) yang mencoba membekukan sel telur atau sperma (penyimpanan kesuburan).
Sebanyak 45% mengatakan mereka ingin atau berencana mengadopsi, dan 21% mengatakan mereka tidak pernah ingin punya anak.
Para penulis menyerukan penelitian lebih lanjut tentang bagaimana keinginan memiliki anak berubah seiring usia dan bagaimana tekanan gender memengaruhi pilihan ini.
Hasilnya menimbulkan pertanyaan tentang persetujuan berdasarkan informasi, karena remaja menolak menyimpan sel telur atau sperma sebelum perawatan yang dapat merusak kesuburan secara permanen, pada usia ketika keinginan mereka tentang menjadi orang tua mungkin berubah.

Abstract

PURPOSE: Research demonstrates a negative psychosocial impact of infertility among otherwise healthy adults, and distress among adolescents facing the prospect of future infertility due to various medical conditions and treatments that impair reproductive health. Guidelines state that providers should counsel transgender youth about potential infertility and fertility preservation (FP) options prior to initiation of hormone therapy. The purpose of this study was to examine the rates of fertility counseling and utilization of FP among a cohort of adolescents with gender dysphoria seen at a large gender clinic.

METHODS: An Institutional Review Board-approved retrospective review of electronic medical records was conducted of all patients with ICD-9/10 codes for gender dysphoria referred to Pediatric Endocrinology for hormone therapy (puberty suppression and/or cross-sex hormones) from January 2014 to August 2016.

RESULTS: Seventy-eight patients met inclusion criteria. Five children were prepubertal, no hormone therapy was considered, and they were therefore excluded. Of the remaining 73 patients, 72 had documented fertility counseling prior to initiation of hormone therapy and 2 subjects attempted FP; 45% of subjects mentioned a desire or plan to adopt, and 21% said they had never wanted to have children.

CONCLUSIONS: Utilization rates of FP are low among transgender adolescents. 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. Discussions about infertility risk, FP, and other family building options should be prioritized in this vulnerable adolescent population.

Conclusion

Utilization rates of FP are low among transgender adolescents. 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. Discussions about infertility risk, FP, and other family building options should be prioritized in this vulnerable adolescent population.

Methodological limitations

Based on old records: Information came from what clinicians wrote in medical records, not from interviews or questionnaires. So what was actually said, and the teens' real reasons, cannot be checked.
Small group at one clinic: 73 teens at one US clinic over about 2.5 years makes the numbers imprecise and may not apply to other clinics, countries or later years.
Quality of counselling unknown: A recorded talk only shows a discussion was noted. Later studies (for example Johnson and colleagues, 2024) found big gaps between what clinicians recorded and what patients remembered being told.
Understanding not checked: The study did not test whether teens understood they could become permanently infertile, or could weigh their future wish for children.
Obstacles not measured: Cost, insurance, invasive procedures, the need to delay or pause treatment, and distress about the procedures were not measured. So low uptake cannot be blamed on lack of interest alone.
No follow-up: Teens were not followed into adulthood, so whether they later wanted biological children or regretted not saving eggs or sperm is unknown.
Counts only: The study did not analyse which factors (age, birth sex, stage of puberty, parents' involvement) were linked to choosing fertility preservation.

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Summary

Key findings

Abstract

Conclusion