[性别不一致和出生时性别为男性的人的生育能力保存]。

IF 0.3 4区 医学 Q4 UROLOGY & NEPHROLOGY
Aktuelle Urologie Pub Date : 2025-04-01 Epub Date: 2025-02-05 DOI:10.1055/a-2490-4059
Florian Josef Schneider, Bettina Scheffer, Sabine Kliesch, Jann-Frederik Cremers
{"title":"[性别不一致和出生时性别为男性的人的生育能力保存]。","authors":"Florian Josef Schneider, Bettina Scheffer, Sabine Kliesch, Jann-Frederik Cremers","doi":"10.1055/a-2490-4059","DOIUrl":null,"url":null,"abstract":"<p><p>According to current guidelines, patients with gender incongruence seeking treatment must receive appropriate education and counselling from healthcare professionals on the various options for fertility preservation. Gender-affirming hormonal treatment leads in persons assigned male at birth to a reduction of LH, FSH, and testosterone, which is associated with a regression of spermatogenesis (up to complete loss) and subsequent testicular atrophy. Individuals starting gender-affirming hormonal treatment after having experienced male puberty may provide an ejaculate sample for sperm cryopreservation. In cases where no sperm is detected in the ejaculate due to gender-affirming hormonal treatment, or if the sampling of ejaculate is no longer possible or causes excessive psychological distress, (microsurgical) testicular sperm extraction [(m)TESE] should be offered. Electroejaculation under anaesthesia is rarely effective, as hormonal treatment impairs spermatogenesis. Similarly, microsurgical epididymal sperm aspiration (MESA) is not typically effective for the same reason. If adolescents with gender incongruence undergo puberty blockade and/or gender-affirming hormonal treatment at an early stage of puberty (possible from Tanner stage 2), this prevents the maturation of spermatogonial stem cells into mature sperm. Puberty blockade with GnRH reduces the secretion of LH and FSH by the pituitary gland, which, in turn, suppresses the production of testosterone in the Leydig cells and the stimulation of spermatogenesis in the testicles. In such cases, the cryopreservation of spermatogonial stem cells is possible, similar to how it is offered in some countries for peri-pubertal patients prior to necessary germ cell-toxic treatments. In Germany, there is a relevant network (Androprotect), which was founded in Münster in 2012. Via Androprotect, this procedure is also offered for adolescent individuals with gender incongruence. This approach is considered experimental as no established treatment exists for the refertilisation of affected adults at a later stage, although several procedures for in-vitro sperm maturation and tissue transplantation are under development. The care of patients with gender incongruence should include individual counselling provided by experienced professionals in an interdisciplinary treatment team. Individual treatment approaches should be offered to facilitate shared decision-making (based on informed consent) to ensure that each individual can make an informed and appropriate decision regarding fertility preservation.</p>","PeriodicalId":7513,"journal":{"name":"Aktuelle Urologie","volume":" ","pages":"150-157"},"PeriodicalIF":0.3000,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"[Fertility preservation in persons with gender incongruence and male-assigned sex at birth].\",\"authors\":\"Florian Josef Schneider, Bettina Scheffer, Sabine Kliesch, Jann-Frederik Cremers\",\"doi\":\"10.1055/a-2490-4059\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>According to current guidelines, patients with gender incongruence seeking treatment must receive appropriate education and counselling from healthcare professionals on the various options for fertility preservation. Gender-affirming hormonal treatment leads in persons assigned male at birth to a reduction of LH, FSH, and testosterone, which is associated with a regression of spermatogenesis (up to complete loss) and subsequent testicular atrophy. Individuals starting gender-affirming hormonal treatment after having experienced male puberty may provide an ejaculate sample for sperm cryopreservation. In cases where no sperm is detected in the ejaculate due to gender-affirming hormonal treatment, or if the sampling of ejaculate is no longer possible or causes excessive psychological distress, (microsurgical) testicular sperm extraction [(m)TESE] should be offered. Electroejaculation under anaesthesia is rarely effective, as hormonal treatment impairs spermatogenesis. Similarly, microsurgical epididymal sperm aspiration (MESA) is not typically effective for the same reason. If adolescents with gender incongruence undergo puberty blockade and/or gender-affirming hormonal treatment at an early stage of puberty (possible from Tanner stage 2), this prevents the maturation of spermatogonial stem cells into mature sperm. Puberty blockade with GnRH reduces the secretion of LH and FSH by the pituitary gland, which, in turn, suppresses the production of testosterone in the Leydig cells and the stimulation of spermatogenesis in the testicles. In such cases, the cryopreservation of spermatogonial stem cells is possible, similar to how it is offered in some countries for peri-pubertal patients prior to necessary germ cell-toxic treatments. In Germany, there is a relevant network (Androprotect), which was founded in Münster in 2012. Via Androprotect, this procedure is also offered for adolescent individuals with gender incongruence. This approach is considered experimental as no established treatment exists for the refertilisation of affected adults at a later stage, although several procedures for in-vitro sperm maturation and tissue transplantation are under development. The care of patients with gender incongruence should include individual counselling provided by experienced professionals in an interdisciplinary treatment team. Individual treatment approaches should be offered to facilitate shared decision-making (based on informed consent) to ensure that each individual can make an informed and appropriate decision regarding fertility preservation.</p>\",\"PeriodicalId\":7513,\"journal\":{\"name\":\"Aktuelle Urologie\",\"volume\":\" \",\"pages\":\"150-157\"},\"PeriodicalIF\":0.3000,\"publicationDate\":\"2025-04-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Aktuelle Urologie\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1055/a-2490-4059\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/2/5 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q4\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Aktuelle Urologie","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1055/a-2490-4059","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/2/5 0:00:00","PubModel":"Epub","JCR":"Q4","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 0

摘要

根据目前的指导方针,寻求治疗的性别不一致患者必须接受医疗保健专业人员关于保留生育能力的各种选择的适当教育和咨询。性别确认激素治疗导致出生时被指定为男性的人LH、FSH和睾酮水平降低,这与精子发生功能减退(直至完全丧失)和随后的睾丸萎缩有关。在经历过男性青春期后开始性别确认激素治疗的个体可以提供精子冷冻保存的射精样本。如果由于性别确认激素治疗而未在射精中检测到精子,或者如果射精采样不再可能或导致过度的心理困扰,则应提供(显微外科)睾丸精子提取[(m)TESE]。麻醉下的电射精很少有效,因为激素治疗会损害精子的发生。同样,显微手术附睾精子抽吸(MESA)也不是典型的有效。如果性别不一致的青少年在青春期早期接受青春期阻断和/或性别确认激素治疗(可能来自Tanner阶段2),这会阻止精原干细胞成熟为成熟精子。青春期用GnRH阻断会减少垂体的LH和FSH的分泌,这反过来又会抑制睾丸间质细胞中睾酮的产生和睾丸中精子发生的刺激。在这种情况下,精原干细胞的冷冻保存是可能的,类似于一些国家在必要的生殖细胞毒性治疗之前为青春期周围患者提供的冷冻保存。在德国,有一个相关的网络(Androprotect),它于2012年在德国东南部成立。通过Androprotect,这个程序也提供给性别不一致的青少年。这种方法被认为是实验性的,因为目前还没有确定的治疗方法用于晚期受影响的成年人的再受精,尽管一些体外精子成熟和组织移植的程序正在开发中。性别不一致患者的护理应包括由跨学科治疗团队中经验丰富的专业人员提供的个人咨询。应提供个别治疗方法,以促进共同决策(基于知情同意),以确保每个人都能就保留生育能力作出知情和适当的决定。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
[Fertility preservation in persons with gender incongruence and male-assigned sex at birth].

According to current guidelines, patients with gender incongruence seeking treatment must receive appropriate education and counselling from healthcare professionals on the various options for fertility preservation. Gender-affirming hormonal treatment leads in persons assigned male at birth to a reduction of LH, FSH, and testosterone, which is associated with a regression of spermatogenesis (up to complete loss) and subsequent testicular atrophy. Individuals starting gender-affirming hormonal treatment after having experienced male puberty may provide an ejaculate sample for sperm cryopreservation. In cases where no sperm is detected in the ejaculate due to gender-affirming hormonal treatment, or if the sampling of ejaculate is no longer possible or causes excessive psychological distress, (microsurgical) testicular sperm extraction [(m)TESE] should be offered. Electroejaculation under anaesthesia is rarely effective, as hormonal treatment impairs spermatogenesis. Similarly, microsurgical epididymal sperm aspiration (MESA) is not typically effective for the same reason. If adolescents with gender incongruence undergo puberty blockade and/or gender-affirming hormonal treatment at an early stage of puberty (possible from Tanner stage 2), this prevents the maturation of spermatogonial stem cells into mature sperm. Puberty blockade with GnRH reduces the secretion of LH and FSH by the pituitary gland, which, in turn, suppresses the production of testosterone in the Leydig cells and the stimulation of spermatogenesis in the testicles. In such cases, the cryopreservation of spermatogonial stem cells is possible, similar to how it is offered in some countries for peri-pubertal patients prior to necessary germ cell-toxic treatments. In Germany, there is a relevant network (Androprotect), which was founded in Münster in 2012. Via Androprotect, this procedure is also offered for adolescent individuals with gender incongruence. This approach is considered experimental as no established treatment exists for the refertilisation of affected adults at a later stage, although several procedures for in-vitro sperm maturation and tissue transplantation are under development. The care of patients with gender incongruence should include individual counselling provided by experienced professionals in an interdisciplinary treatment team. Individual treatment approaches should be offered to facilitate shared decision-making (based on informed consent) to ensure that each individual can make an informed and appropriate decision regarding fertility preservation.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
Aktuelle Urologie
Aktuelle Urologie 医学-泌尿学与肾脏学
CiteScore
0.60
自引率
33.30%
发文量
104
审稿时长
>12 weeks
期刊介绍: Die entscheidenden Ergebnisse der internationalen Forschung – für Sie auf den Punkt zusammengefasst und kritisch kommentiert Übersichtsarbeiten zu den maßgeblichen Themen der täglichen Praxis Auf dem Laufenden über die klinische Forschung durch interessante Originalien CME-Punkte sammeln mit der Rubrik "Operative Techniken" In jeder Ausgabe: Techniken wichtiger Standard-OPs – Schritt für Schritt Erstklassige OP-Skizzen mit verständlichen Erläuterungen
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信