Longitudinal reproductive healthcare pathways of transmasculine people.

Background: It is recommended that transgender and gender diverse people receive fertility counselling before the start of gender affirming treatment. During this consultation their reproductive wishes and options for fertility preservation are explored. Transmasculine people have various options to fulfil their reproductive wishes also during gender-affirming treatment. Our aim is to study reproductive wishes and fertility preservation outcome in transmasculine people over time.

Methods: Transmasculine individuals at the Centre of Expertise on Gender Dysphoria (CEGD) in Amsterdam were included in a prospective follow-up cohort study for gynaecological care and received follow-up questionnaires after 6, 12 and 24 months after fertility counselling regarding their reproductive wishes and fertility preservation. Reproductive outcomes were collected from the patient's medical files.

Results: In total, 317 had a fertility consultation at the CEGD, of whom 10% underwent oocyte cryopreservation, 4% cortex preservation, 1% carried a pregnancy, and 12% underwent an ovariectomy. The most common reproductive choices are opting to preserve their internal organs and no fertility preservation wish. During a 2-year follow-up period, reproductive wishes changed in 20% of the participants. This was not related to age, testosterone use or prior puberty suppression. However, there was a trend suggesting that younger age and prior puberty suppression were related to changes in reproductive wishes.

Conclusion: This study showed reproductive wishes of transmasculine individuals over time. Further research is necessary to follow the reproductive outcomes of oocyte cryopreservation, cortex preservation and pregnancy. As well as, factors that influence their future pathway to parenthood.