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

• 연구는 2014년 1월부터 2016년 8월까지 미국 아동 성별 클리닉 한 곳에서 호르몬 치료를 위해 의뢰된 젊은이 78명의 기록을 검토했으며, 사춘기가 시작된 10대 73명이 포함되었습니다.
• 10대 73명 중 72명(99%)이 사춘기 차단제나 반대 성 호르몬을 시작하기 전에 생식 능력에 대한 대화가 기록되어 있었습니다.
• 10대 73명 중 2명(3%)만 난자나 정자를 냉동(생식 능력 보존)하려 했습니다.
• 45%는 입양을 원하거나 계획한다고 했고, 21%는 아이를 원한 적이 없다고 했습니다.
• 저자들은 아이를 갖고 싶은 바람이 나이에 따라 어떻게 바뀌는지, 성별 불쾌감이 이런 선택에 어떤 영향을 주는지에 대한 더 많은 연구를 요구합니다.
• 결과는 사후 동의에 의문을 제기합니다. 10대가 생식 능력을 영구히 해칠 수 있는 치료 전에, 부모가 되는 것에 대한 바람이 바뀔 수 있는 나이에 난자나 정자 보존을 거절했기 때문입니다.

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.