An intervention to increase fertility preservation counseling prior to starting gender-affirming hormone therapy.

Abstract

Purpose: To determine if an educational handout regarding fertility preservation options affected rates of fertility preservation counseling, REI referrals, and gamete cryopreservation in transgender and non-binary adolescents.

Methods: This was a retrospective observational pre/post intervention study of patients seen at a single academic gender-affirming care clinic and were prescribed gender-affirming hormone therapy from January 2022 to January 2023 and April 2023 to April 2024.

Exposure: Educational handout MAIN OUTCOME MEASURES: The primary outcome was the rate of fertility preservation counseling.

Results: There were 208 eligible patients, with 143 in the pre-intervention group and 65 in the post-intervention group. There was a significant increase in fertility preservation counseling rates after implementing the educational handout (31.5% counseling rate pre-intervention vs 58.46% post-intervention, percentage change 26.9%, SE 7.3%, p <0.001). Of the patients counseled on fertility preservation, there was no significant difference in REI referral rates (percentage change -3.2%, SE 6.5%, p=0.6208) or in gamete cryopreservation.

Discussion: Increased access to educational materials increases the rate of fertility preservation counseling in transgender and non-binary adolescents. More research is needed to determine how to improve resources and empower adolescents and their families to make informed decisions regarding reproductive health.

Implications and contribution: Clinicians who provide gender-affirming medical care should be equipped with educational resources they can offer their patients. Increased education and counseling may assist patients in making an informed decision regarding their fertility, regardless of whether or not they choose to preserve their fertility.