Low Fertility Preservation Utilization Among Transgender Youth.
OBJECTIVE
Research demonstrates a negative psychosocial impact of infertility among otherwise healthy adults, and distress among adolescents facing the prospect of future infertility due to various medical conditions and treatments that impair reproductive health. Guidelines state that providers should counsel transgender youth about potential infertility and fertility preservation (FP) options prior to initiation of hormone therapy. The purpose of this study was to examine the rates of fertility counseling and utilization of FP among a cohort of adolescents with gender dysphoria seen at a large gender clinic.


METHODS
An Institutional Review Board-approved retrospective review of electronic medical records was conducted of all patients with ICD-9/10 codes for gender dysphoria referred to Pediatric Endocrinology for hormone therapy (puberty suppression and/or cross-sex hormones) from January 2014 to August 2016.


RESULTS
Seventy-eight patients met inclusion criteria. Five children were prepubertal, no hormone therapy was considered, and they were therefore excluded. Of the remaining 73 patients, 72 had documented fertility counseling prior to initiation of hormone therapy and 2 subjects attempted FP; 45% of subjects mentioned a desire or plan to adopt, and 21% said they had never wanted to have children.


CONCLUSIONS
Utilization rates of FP are low among transgender adolescents. More research is needed to understand parenthood goals among transgender youth at different ages and developmental stages and to explore the impact of gender dysphoria on decision-making about FP and parenthood. Discussions about infertility risk, FP, and other family building options should be prioritized in this vulnerable adolescent population.
Division of Endocrinology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio; Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio. Electronic address: leena.nahata@nationwidechildrens.org.
Leena
L
Nahata
Harvard Medical School, Boston, Massachusetts; Departments of Psychiatry, Urology, and Endocrinology, Boston Children's Hospital, Boston, Massachusetts.
Amy C
AC
Tishelman
Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.
Nicole M
NM
Caltabellotta
Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, Florida; Morsani College of Medicine, University of South Florida, Tampa, Florida.
Gwendolyn P
GP
Quinn
D000293:Adolescent; D057286:Electronic Health Records; D005260:Female; D005298:Fertility / Q000187:drug effects*; D059247:Fertility Preservation / Q000706:statistics & numerical data*; D000068116:Gender Dysphoria / Q000188:drug therapy; D012739:Gonadal Steroid Hormones / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D063106:Transgender Persons; D016312:Treatment Refusal
D012739:Gonadal Steroid Hormones
Adolescents; Adoption; Fertility; Fertility preservation; Infertility; LGBTQ; Parenthood; Transgender; Utilization rates; Youth