Category: Fertility
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The combination of puberty blockers followed by cross-sex hormones leads to permanent loss of fertility
A 2024 systematic review notes that puberty suppression alone does not necessarily eliminate future fertility, as endogenous puberty may resume after treatment stops. However, when puberty blockers are followed by cross-sex hormones, fertility potential may be significantly impaired or permanently lost, particularly if fertility preservation has not occurred beforehand. This review therefore highlights that fertility risks emerge through the sequential treatment pathway from puberty suppression to cross-sex hormones.
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
PDF: Full paper PDF -
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
PDF: Full paper PDF -
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 al1. 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.
- 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] ↩︎
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While long-term study is lacking, one case study suggests that tucking can affect fertility
In a case study1 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 study2 found that tucking could create a suboptimal environment for spermatogenesis.
- Trussler, J. T., & Carrasquillo, R. J. (2020). Cryptozoospermia Associated With Genital Tucking Behavior in a Transwoman. Reviews in urology, 22 (4), 170–173. [Link] ↩︎
- Debarbo, C.J.M. (2020). Rare cause of testicular torsion in a transwoman: A case report. Urology Case Reports 33. [Link] ↩︎
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Medical transition puts both males and females at risk of infertility
A wide-ranging study1 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.
- 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] ↩︎