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

• Дослідження переглянуло записи 78 молодих людей, направлених на гормональне лікування в одній американській дитячій гендерній клініці з січня 2014 до серпня 2016 року; 73 підлітки, які почали пубертат, були включені.
• У 72 із 73 підлітків (99%) була записана розмова про фертильність перед початком блокаторів пубертату чи гормонів протилежної статі.
• Лише 2 із 73 підлітків (3%) спробували заморозити яйцеклітини чи сперму (збереження фертильності).
• 45% сказали, що хотіли або планували всиновлення, а 21% сказали, що ніколи не хотіли дітей.
• Автори закликають до більше досліджень того, як бажання мати дітей змінюються з віком і як гендерний дистрес впливає на ці вибори.
• Результати порушують питання про інформовану згоду, бо підлітки відмовилися від збереження яйцеклітин чи сперми перед лікуванням, яке може остаточно зашкодити фертильності, у віці, коли їхні бажання щодо батьківства можуть змінитися.

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.