ESPE Yearbook of Paediatric Endocrinology

Reprod Sci. 2022 Jan;29(1):260-269. PMID: 33788173, doi: 10.1007/s43032-021-00561-y.

Brief Summary: This study from Israel investigated semen samples from 26 transgender girls aged 14-18 years and notes a general reduction in semen quality parameters.

Fertility counselling is mandatory in all transgender adolescents prior to considering hormone interventions, but in reality how successful is the process of fertility preservation? In this patient cohort of transgender girls, all except two had completed male puberty and all reproductive hormone parameters were within normal limits. A mean of three semen samples per person were collected. In comparison with WHO references, semen volume, sperm concentration, total sperm count and motility were all lower. There was a higher rate of abnormal sperm morphology also. The post cryopreservation thaw analysis showed that the samples were suitable only for intracytoplasmic sperm injection procedures and not conventional intrauterine insemination.

The authors explore potential reasons for this but did not find any direct associations. The young age of the cohort could be an explanation as semen quality improves with age. Around 25% were on psychotropic medications for depression and/or anxiety. Additionally, 28% practised ‘tucking’ of the genitalia. There were also suggestions for further research into biological mechanisms such as genetic variations in the androgen receptor and estrogen receptor ß. Low prenatal testosterone concentrations have been linked with gender incongruence and impaired spermatogenesis but this concept requires more exploration.

Discussions with young transgender adolescents on their options of creating a family in the future are challenging. However, even if fertility preservation is undertaken, the resulting outcomes may not always be successful.