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

• 该研究回顾了2014年1月至2016年8月间一家美国儿童性别诊所转介接受激素治疗的78名年轻人的病历；纳入了73名已进入青春期的青少年。
• 73名青少年中有72人（99%）在开始青春期阻断剂或跨性别激素之前有关于生育能力的谈话记录。
• 73名青少年中只有2人（3%）尝试冷冻卵子或精子（保留生育能力）。
• 45%说他们想要或计划领养，21%说他们从来不想要孩子。
• 作者呼吁就对生育孩子的愿望如何随年龄变化，以及性别痛苦如何影响这些选择开展更多研究。
• 这些结果对知情同意提出了疑问，因为青少年在可能永久损害生育能力的治疗之前拒绝了保存卵子或精子，而在这个年龄，他们对为人父母的愿望可能会改变。

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.