Solo 2 su 73 adolescenti di una clinica di genere hanno tentato la preservazione della fertilità, pur con consulenza

Basso ricorso alla preservazione della fertilità tra i giovani transgender

Studi di coorte e registro Bloccanti della pubertà Etica medica e consenso

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

Lo studio ha esaminato le cartelle di 78 giovani inviati per un trattamento ormonale presso una clinica statunitense per il genere dei bambini da gennaio 2014 ad agosto 2016; sono stati inclusi 73 adolescenti che avevano iniziato la pubertà.
72 adolescenti su 73 (99%) avevano una conversazione registrata sulla fertilità prima di iniziare i bloccanti della pubertà o gli ormoni cross-sex.
Solo 2 adolescenti su 73 (3%) hanno cercato di congelare ovociti o spermatozoi (preservazione della fertilità).
Il 45% ha detto di voler adottare o di pianificarlo, e il 21% di non aver mai voluto figli.
Gli autori chiedono più ricerca su come i desideri di avere figli cambino con l'età e su come il disagio di genere influisca su queste scelte.
I risultati sollevano interrogativi sul consenso informato, perché gli adolescenti hanno rifiutato di conservare ovociti o spermatozoi prima di trattamenti che possono danneggiare in modo permanente la fertilità, a un'età in cui i loro desideri sulla genitorialità possono cambiare.

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