The importance of fertility preservation in the transgender population

Abstract Introduction The transgender population has long been marginalized by society. Societal stigmata, fear to seek care, and dearth of provider knowledge regarding transgender health issues has caused disparities to widen. Objective The purpose of this case study is to call to attention the often-overlooked aspect of pediatric transgender care: the importance of fertility preservation prior to instituting gender-affirming therapy. Methods Twenty-one genetically XY females, followed by their multidisciplinary transgender care teams, were interested in starting hormone therapy due to impending onset and/or progression of puberty. Fortunately for these patients, their physicians were aware of fertility struggles after undergoing hormone therapy. Results Sperm cryopreservation via open gonadal biopsy, testicular tissue cryopreservation (TTC), and semen sample (when age/maturity-appropriate) were discussed. Though requiring surgery, biopsy/TTC relieves patients of the psychological impact of semen sample production. With IRB approval, 20 patients (median age 12 years, range 10-16 years) underwent TTC (Figure 1). One patient (age 16 years) opted for semen sample. All patients had success with spermatogonial stem cells cryopreserved for future patient use. Conclusions Gender affirming procedures and hormone therapy affect the long-term reproductive potential of transgender individuals. While cost concerns and insurance coverage regarding oncofertility is a prominent area of discussion, the transgender community is often excluded. With more individuals beginning medical and surgical therapy at a younger age, fertility preservation discussions are essential but often overlooked, depriving these individuals the joy of becoming a biological parent. As health care providers, addressing psychological, emotional, physical, and spiritual needs of patients is crucial, and fertility is a key aspect of this care. TTC can be safely done in pediatric populations, though research is necessary to expand beyond current experimental stage of tissue-development. Disclosure No