Fertility in Transgender People: Advances, Challenges, and Future Perspectives
“We must take advantage of society's increasingly open attitude towards transgender people by making progress in addressing their fertility”, Dr. Joana Peñarrubia.
Dr. Joana Peñarrubia, expert in reproductive medicine and coordinator of the Trans Working Group of the Spanish Fertility Society has written, together with other experts, the Good Clinical Practice Guide for the Management of Reproductive Health of Transgender People.
This guide, published by the same scientific society, highlights the importance of advising trans patients about their fertility. Now that society is opening up to this community, we are overcoming the prejudices that used to hinder and complicate their treatment in our medical field.
The main objective of this trans guide is, in the words of Dr. Peñarrubia, “to provide medical professionals involved in the care of transgender people with all the existing knowledge regarding the psychological, ethical-legal and therapeutic aspects of the reproductive health of transgender people”.
In addition, “the different SEF professionals who contributed to this guide have succeeded in producing a complete document that unifies the clinical attitude towards transgender people, including the perspective of experts, service providers and society in general”.
The Impact of Hormone Therapy on Trans Fertility in Spain
Gender-affirming hormone therapy (GAHT), which is essentially the administration of oestrogen in trans women and testosterone in trans men, can have a negative effect on the future fertility of trans people. While this is perhaps the most basic claim, it is also the most important one at the moment.
At present, it is uncertain whether this potentially deleterious effect on reproductive capacity is temporary or permanent. Also unclear is to what extent reproductive capacity can be restored when hormone therapy is discontinued, which may also trigger the appearance of gender dysphoria symptoms in transgender people. Hence the need for a guide that enables us to address and provide answers concerning the management of transgender people's reproductive health.
Fertility Preservation Techniques
Recent advances in fertility preservation techniques have allowed us to address the problem of the possible detrimental effect that gender-affirming hormone therapy may have on fertility. For this reason, reproductive medicine professionals should advise transgender people about the possibility of cryopreserving gametes (oocytes or sperm) either prior to initiating hormone therapy or once it has been completed. This will enable them to opt for the possibility of having their own genetic offspring at some point in the future.
Transgender People: Facts and Fertility
When referring to epidemiological data on the transgender population, it is important to avoid the terms “incidence” and “prevalence” in order to refrain from inappropriately pathologizing transgender people. For this reason, perhaps the most appropriate term is the proportion of the population that identifies as transgender, a proportion that is difficult to establish given the different sources used in the calculation of the sample size.
Recent publications estimate that the percentage of the transgender population oscillates between 1.2% and 2.7%. The increase in recent years of this percentage is joined by a decrease in the age of presentation. There has also been a relative increase in the population of trans men, as compared to that of trans women.
All these demographic factors will clearly influence the importance of the reproductive management of these individuals and of proper counseling on their future fertility.
Recommendations from the SEF Guide for Transgender Patients
The main objective of the trans guide published by the SEF is to provide medical professionals involved in the care of transgender people with all the existing knowledge regarding the psychological, ethical-legal and therapeutic aspects of the reproductive health of transgender people.
In addition, guidelines were developed based mainly on the experience of the group of experts who participated in the guide, given the sparse scientific evidence regarding the reproductive problems of transgender people.
I believe that we have successfully produced a comprehensive document that unifies the clinical attitude towards these individuals, including the perspective of experts, service providers and society in general.
We must clearly take advantage of society's growing openness to transgender people and of the fact that the society has overcome the prejudices that once hindered and complicated the treatment of this group.
What Does the Future Hold for Transgender Patients?
For trans individuals, a possible combination of gender-affirming hormone therapy with their reproductive future depends on the possibility of cryopreserving gametes for later use. While gender-affirming hormone therapy allows trans persons to live in accordance with their identified gender, it may have a deleterious effect on their fertility. It is therefore essential that transgender people who are going to start gender-affirming hormone therapy be fully informed of its potential effects on their reproductive capacity and of the possibility of preserving oocytes or spermatozoa according to their identified gender and the gender with which they live.
In conclusion, society’s growing acceptance of transgender individuals presents a unique opportunity to advance the management of their reproductive health. Innovations in fertility preservation, reproductive technology, and social awareness are laying the groundwork to ensure everyone can exercise their right to form a family, regardless of gender identity.
Building inclusive and respectful care requires joint efforts from healthcare professionals, policymakers, and society as a whole. Only through collaboration can we create a future where assisted reproduction is truly accessible for all.
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