Reproductive Considerations in the Transgender and Gender Diverse Population: A Review

While an essential component of gender-affirming care, hormone therapies impact reproductive potential. Studies show that nearly 50% of TGD individuals express a desire for future children3 3 and more than 70% think about FP, though only a minority pursues it.7 7 Common barriers to pursing FP include cost, lack of proper counseling, and an individual's desire to proceed with gender-affirming treatment without any further delay. To mitigate these barriers, the ASRM joins the WAPATH and the Endocrine Society in strongly recommending that all TGD individuals be counseled regarding fertility prior to initiating medical and/or surgical gender-affirming treatments.12 12 The goal of the fertility consultation should be to discuss reproductive potential after transitioning and strategize for future family building if desired. Existing options for future reproduction include gonadal tissue cryopreservation (for prepubertal individuals), gametes or embryo cryopreservation (for postpubertal individuals), third party reproduction (such as donor sperm/mature oocytes and gestational carrier), and adoption. A multidisciplinary approach to care throughout the process of FP is necessary as individuals, particularly adolescents and young adults are at increased risk for psychological and physical distress due to gender incongruent experiences. FP should be individualized based on the timing, type, and duration of gender-affirming treatments. While there have been advances in the technology and standardization of reproductive health care for TGD individuals, many gaps remain in our knowledge which require further research and evidence-based approaches to caring for this population.