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Why fertility preservation rates of transgender men are much lower than those of transgender women

  • Sharon Alpern
    Affiliations
    Sara Racine IVF Unit, Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, (affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel), Tel Aviv, Israel
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  • Iris Yaish
    Affiliations
    Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, (affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel), Tel Aviv, Israel
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  • Gal Wagner-Kolasko
    Affiliations
    Department of Family Medicine, Tel Aviv District, Clalit Gan Meir LGBT Clinic, Israel
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  • Yona Greenman
    Affiliations
    Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, (affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel), Tel Aviv, Israel
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  • Yael Sofer
    Affiliations
    Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, (affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel), Tel Aviv, Israel
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  • Dror Paltiel Lifshitz
    Affiliations
    Department of Obstetrics and Gynecology, Sheba Medical Center, (affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel), Tel Hashomer, Israel
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  • Asnat Groutz
    Affiliations
    Sara Racine IVF Unit, Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, (affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel), Tel Aviv, Israel
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  • Foad Azem
    Affiliations
    Sara Racine IVF Unit, Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, (affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel), Tel Aviv, Israel
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  • Hadar Amir
    Correspondence
    Corresponding author.
    Affiliations
    Sara Racine IVF Unit, Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, (affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel), Tel Aviv, Israel
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Published:January 13, 2022DOI:https://doi.org/10.1016/j.rbmo.2022.01.003

      Abstract

      Research question

      What are the fertility preservation rates of transgender women and transgender men, and what are the factors that affect their decision-making?

      Design

      This prospective study included 97 transgender women and 91 transgender men referred to the Gender Clinic of the study medical centre's Endocrinology Institute and to the Gan Meir Community Health Care Centre. The responders completed a 28-item questionnaire during 2018.

      Results

      Most of the transgender women and transgender men wished to parent a child (67.4% and 61.9%, respectively, P = 0.447), but only 40.4% of the transgender women and 5.8% of the transgender men used fertility preservation (P < 0.001). The main reasons for not pursuing fertility preservation were unwillingness to postpone gender-affirming treatment (58.8% and 74.0%, respectively, P = 0.076), preference to adopt a child (58.8% and 60.9%, respectively, P = 0.818) and cost (44.9% and 60.9%, respectively, P = 0.086). Factors related to the fertility preservation process itself were specifically chosen by transgender men compared with transgender women as the reason for not pursuing this treatment, including distress caused by the fertility preservation technique (60.3% versus 29.3%, respectively, P = 0.006), fear of gender dysphoria caused by hormonal treatment (63.5% versus 28.3%, P = 0.002) and concern over the attitude of medical staff (44% versus 19%, P = 0.027).

      Conclusions

      Fertility preservation rates were considerably lower among transgender men than transgender women, strongly related to the fertility preservation process itself. Finding ways to overcome the obstacles confronted by transgender individuals, especially transgender men, will enhance their future biological parenting.

      Keywords

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      Biography

      Sharon Alpern received her BSc from the Ben-Gurion University of the Negev, Israel. She completed her MD at Tel-Aviv University, Israel, and is currently a Senior Gynecology Resident at the Sourasky Medical Center, Israel. Dr Alpern has a special interest in reproductive endocrinology, infertility and fertility preservation.
      Key message
      Fertility preservation rates of transgender individuals are low, with much lower rates among transgender men. Factors related to the fertility preservation process itself were implicated in these low rates. Overcoming the obstacles confronted by transgender individuals, especially transgender men, will facilitate their fertility preservation and enhance their biological parenting rate.