Ovarian Reserve Well Preserved in Transgender Men After 1 Year of Testosterone Therapy

Illustration of the female reproductive system.
Investigators examined markers of ovarian reserve during testosterone therapy in transgender men.

Ovary function is preserved in transgender men even after 1 year of testosterone therapy, according to an abstract presented at ENDO 2019: The Endocrine Society Annual Meeting, held March 23 to 26 in New Orleans, Louisiana.1

Even though transgender men have carried out successful pregnancies, the long-term effects of testosterone therapy on fertility remain unknown. As such, in this prospective, open-label study, researchers recruited 52 transgender men receiving testosterone therapy to study the markers of ovarian reserve. Data were collected at baseline and 12 months after treatment initiation.

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Of the 52 participants, 32% were in a stable relationship, 50% were unsure about future parenthood, and 7% had already undergone fertility preservation procedures. The average age was 23.4 ± 6.1 years. Complete data were available for 32 participants.

Compared with baseline, testosterone levels increased (0.84 vs 7 nmol/L; P <.0001) and estradiol levels decreased (90.8 vs 55.4 pmol/L; P =.0013) at 12 months of treatment. There was a concomitant decrease in luteinizing hormone (7.56 vs 3.8 mIU/mL; P =.0012), but not follicle-stimulating hormone (5.1 vs 4 mIU/mL; P =.07) levels.

Despite the increase in testosterone levels and decrease in estradiol levels, however, anti-Müllerian hormone levels decreased only slightly, going from 5.65 ng/mL at baseline to 4.89 ng/mL at 12 months (P =.036). This likely indicates “well-preserved ovarian reserve,” noted the researchers, which was further highlighted by the fact that antral follicular count and endometrial thickness also remained unchanged.

“Although there is a need to investigate the effects of testosterone on further fertility parameters such as quality of oocytes and in vitro fertilized embryos, these results are a further step toward providing transgender people basic rights such as reproduction,” said Yona Greenman, MD, the study’s lead investigator, in a press release.2

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1. Yaish I, Malinger G, Foad A, et al. Evidence for preserved ovarian reserve in transgender men receiving testosterone therapy: anti-Müllerian hormone serum levels decrease modestly after one year of treatment. Presented at: ENDO 2019; March 23-26, 2019; New Orleans, LA. Abstract OR11-3.

2. Ovary function is preserved in transgender men at one year of testosterone therapy [press release]. Washington, DC: Endocrine Society; March 23, 2019. Accessed March 23, 2019.