Fertility

  • Medical transition puts both males and females at risk of infertility. Expand
    Download as PDFDownload
    Medical transition puts both males and females at risk of infertility.

    A wide-ranging study [1] found that gender-related drug regimens place patients at risk of infertility:

    Suppression of puberty with gonadotropin-releasing hormone agonist analogs (GnRHa) in the pediatric transgender patient can pause the maturation of germ cells, and thus, affect fertility potential. Testosterone therapy in transgender men can suppress ovulation and alter ovarian histology, while estrogen therapy in transgender women can lead to impaired spermatogenesis and testicular atrophy. The effect of hormone therapy on fertility is potentially reversible, but the extent is unclear.

    On surgeries, the study noted that cross-sex surgery that includes hysterectomy and oophorectomy in transmen or orchiectomy in transwomen results in permanent sterility.

    REFERENCES

    [1] Cheng, P.J., Pastuszak, A.W., Myers, J.B., Goodwin, I.A. & Hotaling, J.M. (2019). Fertility concerns of the transgender patient. Transl Androl Urol. 8 (3): 209-218. [Link]

    Hormones
    Females
    Fertility
    Males
    Medical transition
    PUBERTY BLOCKERS
    Surgery

  • While long-term study is lacking, one case study suggests that tucking can affect fertility. Expand
    Download as PDFDownload
    While long-term study is lacking, one case study suggests that tucking can affect fertility.

    In a case study [1] of one transwoman, tucking resulted in oligospermia – an abnormally low sperm count – affecting fertility. Elevation of the testes because of tucking may contribute to heat stress and consequent impairment of spermatogenesis.

    After cessation of tucking and the provision of a new sperm sample, the sperm count in the patient was improved, and the semen had increased opacification.

    A further study [2] found that tucking could create a suboptimal environment for spermatogenesis.

    REFERENCES

    [1] Trussler, J. T., & Carrasquillo, R. J. (2020). Cryptozoospermia Associated With Genital Tucking Behavior in a Transwoman. Reviews in urology, 22 (4), 170–173. [Link]

    [2] Debarbo, C.J.M. (2020). Rare cause of testicular torsion in a transwoman: A case report. Urology Case Reports 33. [Link]

    Fertility
    males
    Research quality
    Social transition
    Tucking

  • Long term testosterone use potentially compromises fertility and negatively affects ovarian follicle health
    Download as PDFDownload
    Long term testosterone use potentially compromises fertility and negatively affects ovarian follicle health.

    One study in 2023 found that long-term testosterone exposure, as seen in transgender men undergoing gender-affirming therapy, could potentially compromise fertility by negatively affecting ovarian follicle growth, health, and DNA integrity.

    In 2023, a study by Bailie et al. [1] explored the effects of long-term testosterone exposure on ovarian follicles in transgender men receiving gender-affirming endocrine therapy. The research indicated that testosterone was linked with decreased follicle growth activation, poor follicle health, and increased DNA damage, suggesting possible impacts on fertility. Further, these negative effects were intensified following six days of in vitro culture. These findings may have crucial implications for reproductive health and fertility considerations among transgender men receiving testosterone as part of their gender-affirming therapy.

    REFERENCES

    Bailie, E., Maidarti, M., Hawthorn, R., Jack, S., Watson, N., Telfer, E. E., & Anderson, R. A. (2023). The ovaries of transgender men indicate effects of high dose testosterone on the primordial and early growing follicle pool. Reproduction and Fertility, 4(2). [Link]

    females
    fertility
    hormones
    medical transition
    sexual function
    testosterone