Endocrine Abstracts

Objectives: Transgender persons undergoing gender affirming hormonal and/or surgical care, are at risk of reduced fertility. Although theoretically, the options for assigned male at birth (AMAB) transgender people to fulfill their child wish are extensive, research in transgender women shows low fertility preservation utilization. Ideas and concerns of AMAB transgender persons regarding fertility preservation and child wish have never been reported in a large, non-clinical sample.

Materials and methods: A web-based survey on fertility and parenthood was conducted in Belgium in 2017, which invited persons aged ≥16 years who identified themselves as trans* to participate. AMAB transgender people were selected for this substudy, including transgender women (TW), transvestites and gender non binary (GNB) persons.

Results: The questionnaire was filled out by 426 participants; 254 (59.6%) AMAB (196; 77.2% transgender women (TW), 14; 5.5% transvestites and 44; 17.3% GNB persons). Fifty-five (21.6%) respondents had a current/future child wish, child wish was fulfilled in 81 (31.9%) and inexistent in 57 persons (22.4%) (other: 19.2%). Although TW were older than GNB (P=0.14), TW were more likely to have a child wish (P=0.004). In total, 196 AMAB persons (77.2%; TW: 167; 85.2% and GNB: 23; 52.3%) previously sought medical help for their gender identity, of which 30 (15.3%) considered the loss of fertility due to the transitioning process undesirable. The majority (75; 68.2% – 86 missing) did not wish for fertility preservation. Of the total AMAB population, 14 people (9.8% – 112 missing, TW: 12; 10.3%, GNB: 2; 7.7%) had frozen germ cells. The top three reasons not to proceed with fertility preservation included not feeling the need (70; 68.0%), not desiring a genetic link with (future) child(ren) (20; 19.4%) and having to postpone hormone treatment (15; 14.6%). Barriers encountered for fulfilling child wish included assumed difficulties in the adoption procedure (40; 16.1%) and fear of discrimination against the child (38; 15.3)

Conclusion: Child wish and fertility preservation utilization were lower in our AMAB population than in previous research on clinical samples. These low utilization rates reflect barriers transgender persons face when considering fertility options, including postponing hormone therapy. In the present study, TW more frequently visited a health care professional and were more likely to have a child wish, compared to GNB persons. Subsequently, TW were more likely to have germ cells frozen/consider doing so in the future, compared to GNB persons, but the use of fertility preservation remained low.