Freezing for the future: Transgender youth respond to medical fertility preservation

Abstract

Abstract Background: The medical community is paying increasing attention to the healthcare needs of adolescents diagnosed with gender dysphoria who desire medical interventions to bring their bodies and gender identity into alignment. Transgender (i.e. trans) youth initiating gender-affirming hormone treatment (estrogen for birth-assigned males, testosterone for birth-assigned females) after progressing through their endogenous puberty may experience impairment in gonadal function leading to infertility or biological sterility. Gamete cryopreservation (i.e. egg/sperm “freezing”) offers youth pursuing gender-affirming hormone treatment the potential for future biological parenthood. Aims: Given the dearth of qualitative research on trans adolescents considering fertility preservation measures, we sought to explore trans youth’s initial reactions to and opinions of currently existing technologies and their importance in medical decision-making. Methods: We conducted intensive semi-structured interviews with trans adolescents and young adults (n = 18) ages 15–24 about their gender-related medical care and decision-making processes around existing fertility preservation options. Results: In the course of analysis, three major themes recurred: (1) youth discussed a desire to decouple their reproductive biology from their gender, (2) youth felt limited by existing reproductive technologies and discussed imagined parenting futures enabled by anticipated scientific advancements, and (3) youth emphasized the role of their individual identity, personal experiences, and family relationships in decision-making about preserving eggs or sperm for future biological parenthood. Discussion: These findings suggest trans youth may have complex experiences with limitations presented by existing fertility preservation technologies. Providers tasked with assisting trans individuals and their families with decision-making about fertility preservation prior to medical transition may benefit from the diverse perspectives and opinions on these technologies offered by this younger population.