Endocrine Abstracts

Introduction: Utilization rates of fertility preservation among transgender adolescents (TA) are low. Few studies have addressed the reproductive desires of this population. The aim of this study was to assess TA parenthood goals, attitudes about fertility preservation (FP) and perceived barriers to successful gamete banking.

Methods: Transgender adolescents who attended the Gender Identity Development Service (GIDS - endocrine clinic) between March and June 2018, were invited to complete an online survey based on a modified version of The Transgender Youth Fertility Attitudes Questionnaire (TYFAQ).

Results: The questionnaire was answered by 40 TA (27 trans-males): 8 (20%) were younger than 16 years old and 32 (80%) were 16 years and older. 35 individuals (87.5%) received pharmacological therapy for their gender: GnRH analogue (57.1%), combination of GnRH analogue and cross sex hormones (28.57%) or contraceptive pill (2.85%). 23 TA (57.5%) expressed their positive desire of having children either biologically related (22.5%) or adopted (35%) and only 6 TA of 14 who did not want to have children or were unsure about it, acknowledged that their decision could change when older. Regarding fertility implications of gender dysphoria treatment 40 TA strongly agreed (42.5%) or agreed (57.5%) that counselling was important. Information given by psychologist, endocrinologist, general practitioners and fertility units was rated good or very good by 34 (89.5%), 28 (75.7%), 13 (37.1%) and 9 (28.1%) individuals respectively. 39 participants (97.5%) reported a good understanding of available FP methods but utilization rates were low among the whole group: 5 TA (1 trans-male and 4 trans-females). Barriers to access FP in descending order were: incongruence between perceived gender and biological parental role in trans-males and discomfort with FP procedures in trans-females, invasiveness of procedures for trans-males and cost for trans-females and delay of pharmacological intervention for both groups.

Conclusions: More than half of TA expressed interest in parenthood options and agreed that FP counselling was relevant. Unfortunately FP utilisation rate in this population is low. Guidelines and pathways design should consider TA unique fertility and reproductive health needs.