In brief: Gender-affirming treatments for gender dysphoria can impact fertility. This review describes the impact of gender-affirming treatments on fertility and options to preserve fertility in transgender or gender-diverse children, adolescents, and young adults.
Abstract: Transgender individuals who pursue alignment with their gender identity through medical treatments or surgery face challenges to family building because the medical community lacks the understanding or infrastructure to serve the reproductive needs of transgender or non-binary people. Fertility preservation (FP) offers a crucial opportunity for the transgender community, enabling individuals to exercise autonomy over their reproductive choices. While fertility preservation has been extensively studied in other populations such as cancer patients, the unique biology and clinical care of transgender and gender-diverse (TGD) individuals have challenged the direct translation of what can be offered for cisgender individuals. Additionally, the FP services in transgender communities are reportedly under-utilized, despite the prevalent desire of TGD individuals to have children. This review aims to provide up-to-date information on the current standard of care and experimental FP options available to TGD individuals and their potential reproductive outcomes. We will also discuss the barriers to the success of FP utilization from both the biology/medical aspect and the perspectives of the TGD population. By recognizing the unique family-building challenges faced by TGD people and potential areas of improvement, appropriate adjustments can be made to better support fertility preservation in the TGD community.
