Fertility Intentions and Histories Among Transgender Adults Who Started Gender-Affirming Testosterone Before Adulthood

Abstract

Background

As more transgender adolescents and young adults seek gender-affirming care, questions persist about how their desire for potentially fertility-affecting treatment intersects with their fertility intentions.

Methods

We surveyed 125 individuals born with a uterus and ovaries, living in the United States, initially prescribed gender-affirming testosterone at or before age 18, about their interest in genetically related children and history of fertility preservation and fertility-affecting procedures.

Results

Twenty-two percent of respondents did not want children, and 47% wanted children but did not think a genetic relationship was important. Another 8% indicated having genetically related children was important and 17% indicated they did not know. Only 47% recalled counseling about fertility preservation. Those who might want genetically related children were less satisfied when they did not recall counseling (p = .001). Significantly more people in the group who might want genetically related children still had one or both ovaries (100% vs. 86%; p = .03), desired to carry a pregnancy in the future or were unsure (30% vs. 8%; p = .01), and either desired to use their eggs for genetically related children or were unsure (93% vs. 26%; p < .001).

Conclusions

More than one-half of individuals prescribed gender-affirming testosterone as adolescents had no interest in genetically related children. Those who were interested in genetically related children were more likely to have other fertility-preserving interests and behaviors, including potentially desiring a pregnancy and still having one or both ovaries. This finding suggests that fertility-related behaviors of individuals prescribed gender-affirming testosterone are in line with their stated goals.