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Doctors Need Help to Advise on Family Planning in Transgender Men

Providers are ill-equipped to handle family planning for transgender men and clinicians could use clear guidelines to ensure the best outcomes for their patients in this regard, according to new research.

A mini-review of published articles about fertility preservation in transgender men led researchers at Rutgers Robert Wood Johnson Medical School in New Brunswick, New Jersey to report that few providers addressed the issue of fertility counseling for transgender parents.

Their recommendations have been published in the journal Fertility & Sterility Reports.

“Fertility preservation is important to discuss with patients prior to beginning gender-affirming interventions like hysterectomy and removal of ovaries, which result in irreversible infertility,” said co-author Juana Hutchinson-Colas, MD, who is director of the Division of Female Pelvic Medicine and Reconstructive Surgery at Rutgers Robert Wood Johnson Medical School, in a news release on the research.

About 1.4 million adults and 150,000 young people in the United States identify as transgender.  

First author Selena U. Park, MD, Department of Obstetrics, Gynecology and Reproductive Sciences at Rutgers, writes in the article that “although not every transgender patient is interested in having biological children, many indicate that they may have pursued fertility preservation if options were offered at the time of gender transition.”

Overall, the authors recommend that healthcare providers should recognize the limits of their own experience in providing information on fertility preservation; acknowledge that transgender men have similar family planning goals to cisgender counterparts; be aware of intrinsic biases that may affect how fertility counseling is delivered; and offer fertility preservation counseling to everyone regardless of their identity before they begin the transition process.

This should include discussions about ovarian tissue cryopreservation — the only procedure that can be offered to adolescents before puberty — as well as oocyte or embryo preservation, which are preferred post-puberty, as well as contraception counseling, including addressing the misconception that testosterone is an effective contraceptive.

They also advise using a multidisciplinary approach when counseling about fertility services and reassuring patients that research shows children of transgender parents are not adversely affected and few experience psychosocial problems, identity distress, depression, or gender dysphoria.

Hutchinson-Colas emphasizes overall that transgender youth and adolescents should be advised that the long-term impact of hormonal treatment for transitioning on fertility remains unclear. Children identifying as transgender and their parents should “be counseled on the effect of puberty suppression medications and the psychosocial implications of treatments.”

However, she added, “Fertility preservation options for transgender men can be pursued during any stage of gender transition, even after gender-affirming hormonal therapy has started.” 

The authors reviewed six medical databases as part of their research, noting that there isn’t much published evidence in this field.

“With the help of the suggested guidelines presented in our mini-review, we hope to further the conversation about family building in the transgender community,” Park and colleagues conclude.

The authors have reported no relevant financial relationships.

F&S Reports. Published online July 19, 2022. Full text

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