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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, Tel Aviv, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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  • Iris Yaish
    Affiliations
    Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 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, Tel Aviv, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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  • Yael Sofer
    Affiliations
    Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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  • Dror Paltiel Lifshitz
    Affiliations
    Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 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, Tel Aviv, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 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, Tel Aviv, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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  • Hadar Amir
    Correspondence
    Corresponding author: Hadar Amir, Sara Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, 6 Weizman Street, Tel Aviv 6423906, Israel. Tel: +972524744002; Fax: +972-3-6925687.
    Affiliations
    Sara Racine IVF Unit, Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
    Search for articles by this author
Published:January 13, 2022DOI:https://doi.org/10.1016/j.rbmo.2022.01.003

      ABSTRACT

      Research question

      What are the fertility preservation (FP) rates of transgender women and transgender men, and which factors affect their decision making?

      Design

      This prospective study included 97 transgender women and 91 transgender men referred to the Gender Clinic of our medical center's Endocrinology Institute and to the Gan Meir Community Health Care Center. 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 utilized FP (P < 0.001). The main reasons for not pursuing FP were unwillingness to postpone gender-affirming treatment (58.8% and 74%, 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 FP process itself were specifically chosen by transgender men compared to transgender women as the reason for not pursuing FP, including distress from the FP technique (60.3% versus 29.3%, respectively, P = 0.006), fear of gender dysphoria due to hormonal treatment (63.5% versus 28.3%, P = 0.002), and concern over the medical staff's attitude (44% versus 19%, P = 0.027).

      Conclusions

      FP rates were considerably lower among transgender men compared to transgender women, highly related to the FP process itself. Finding ways to overcome the obstacles confronted by transgender individuals, especially transgender men, will enhance their future biological parenting.

      Keywords

      Abbreviations:

      FP (Fertility preservation), GAH (Gender-affirming hormone), GAS (gender-affirming surgery)
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      Biography

      Sharon Alpern received her BSc from the Ben-Gurion University of the Negev, Israel. She completed 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 (FP) rates of transgender individuals are low, with much lower rates among transgender men. Factors related to the FP process itself were implicated in these low rates. Overcoming the obstacles confronted by transgender individuals, especially transgender men, will facilitate their FP and enhance their biological parenting rate.