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