Fertility preservation creates an iatrogenic tension between protecting future fertility and imposing immediate psychological burden

Fertility preservation is often recommended before cross-sex hormones because these treatments may impair future fertility. However, studies report that the procedures required for egg or sperm retrieval are frequently experienced by adolescents and young adults with gender dysphoria as psychologically distressing, physically invasive, or emotionally intolerable. As a result, many decline fertility preservation altogether. This creates an iatrogenic tension in which a medical intervention intended to protect future reproductive autonomy may itself become a source of distress and reduced decision-making capacity.

^{Zepf, F.D. et al. (2024). Beyond NICE: Aktualisierte systematische Übersicht zur Evidenzlage der Pubertätsblockade und Hormongabe bei Minderjährigen mit Geschlechtsdysphorie. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 1-21. DOI: 10.1024/1422-4917/a000972
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