Endocrine Abstracts

Objectives: Gender affirming hormonal and/or surgical care is associated with reduced fertility. Over the last years, the options for transgender persons to fulfill their child wish have increased. Previous research (mainly focused on transgender persons visiting health care professionals) on fertility in transgender persons assigned female at birth (AFAB) shows low fertility preservation utilization. Ideas and concerns of AFAB transgender persons regarding fertility preservation and child wish have never been reported in a large, non-clinical sample.

Materials and methods: An anonymous web-based survey on fertility and parenthood was conducted in Belgium in 2017, which invited all persons aged ≥16 years who identified themselves as trans* to participate. AFAB transgender people were selected for this substudy, which included transgender men (TM) and gender non binary (GNB) persons).

Results: The questionnaire was filled out by 426 participants, of which 172 (40.4%) AFAB (141; 68.8% TM and 64; 31.2% GNB). Sixty-one (35.5%) respondents had a current/future child wish. Child wish was fulfilled in 14 (8.1%) and inexistent in 64 persons (37.2%) (other categories: 19.2%). Child wish did not differ between TM and GNB persons (P=0.304). In total, 130 AFAB persons (75.6%; TM: 99; 85.3% and GNB: 31; 55.4%) had previously sought medical help for their gender identity, of which 27 (20.8%) considered the loss of fertility due to the transitioning process undesirable and of which half (75; 57.7%) did not wish for fertility preservation. Of the total AFAB population, 14 people (10.3% - 79 missing, TM: 12; 12.9%, GNB: 2; 4.8%) had frozen germ cells. The top three reasons not to proceed with fertility preservation included not feeling the need for this (52; 54.2%), having to take hormones for follicle development (27; 28.1%) and the price for freezing germ cells (27; 28.1%). Barriers encountered for fulfilling the child wish included: the assumed difficulties in the adoption procedure (38; 41.3%), fear of discrimination against the child (35; 38.0%), fear of being discriminated as a transgender parent (30; 32.6%) and the price for using own genetic material (30; 32.6%).

Conclusion: Although child wish in our AFAB population is comparable to earlier research, we report lower fertility preservation utilization rates, reflecting the barriers transgender persons face when considering fertility options (including the costs and the need to postpone hormone therapy). GNB persons’ opinions regarding fertility are assessed here for the first time, showing different needs for gender affirming treatment and fertility preservation.