For adolescent and young adult transgender patients, semen cryopreservation may be a viable option for fertility preservation, even in patients who have already begun treatment for gender dysphoria, according to study results published in Pediatrics.1

The study included feminizing transgender patients seeking fertility preservation between 2015 and 2018 (n=11). The researchers retrospectively collected patient data, including age at initial consultation and semen analysis parameters. They also collected information regarding history of gonadotropin-releasing hormone (GnRH) agonist use and/or gendering-affirming therapy.

Median age at consultation was 19.5 years with a range of 16 to 24 years. Of 11 patients, 10 completed ≥1 semen collection and 8 cryopreserved semen before initiating gonadotropin-releasing hormone agonist treatment.

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All patients who had semen cryopreserved exhibited low morphology (6%), with otherwise normal median semen analysis parameters.

Of the two patients who had received previous treatment with a GnRH agonist or gender-affirming therapy, one discontinued leuprolide acetate in order to attempt fertility preservation. Transient azoospermia lasted for 5 months after the final dose of medication with a subsequent recovery of spermatogenesis, after which semen cryopreservation was attempted. As with the untreated patients, morphology was low (9%).

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In the second patient who had previously been treated with spironolactone and estradiol, semen analysis showed persistent azoospermia for 4 months leading up to scheduled orchiectomy after discontinuing both treatments.

The researchers noted three areas for further research, including the length of time needed for spermatogenesis to return after GnRH agonist discontinuation, the long-term effects of gender-affirming therapy and prognosis for the return of spermatogenesis in patients presenting with azoospermia, and whether some transgender patients can cryopreserve sperm without discontinuing gender-affirming therapy.

Writing in a related commentary, Jason Rafferty, MD, MPH, EdM, pediatrician and child psychiatrist at the Adolescent Healthcare Center at Hasbro Children’s Hospital in Providence, Rhode Island, emphasized the need for additional research into these unknowns.2 Despite the fact that adult transgender populations have the same interest in biological children as age-matched peers, providing fertility counseling to transgender youth before medical-affirming interventions is not standardized.

“[M]ore research is critical to characterize the potential for and limitations of fertility preservation, specifically after initiating [medical-affirming interventions], and on alternative approaches that are more effective and/or better tolerated,” wrote Dr Rafferty.2

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1. Barnard EP, Dhar CP, Rothenberg SS, et al. Fertility preservation outcomes in adolescent and young adult feminizing transgender patients. Pediatrics. 2019;144(2):e20183943.

2. Rafferty J. Fertility preservation outcomes and considerations in transgender and gender-diverse youth. Pediatrics. 2019;144(3):e20192000.