Fertility

  • Medical transition puts both males and females at risk of infertility. Expand
    Medical transition puts both males and females at risk of infertility.

    A wide-ranging study [1] found that gender-related drug regimens place patients at risk of infertility:

    Suppression of puberty with gonadotropin-releasing hormone agonist analogs (GnRHa) in the pediatric transgender patient can pause the maturation of germ cells, and thus, affect fertility potential. Testosterone therapy in transgender men can suppress ovulation and alter ovarian histology, while estrogen therapy in transgender women can lead to impaired spermatogenesis and testicular atrophy. The effect of hormone therapy on fertility is potentially reversible, but the extent is unclear.

    On surgeries, the study noted that cross-sex surgery

    that includes hysterectomy and oophorectomy in transmen or orchiectomy in transwomen results in permanent sterility.

    REFERENCES

    [1] Cheng, P.J., Pastuszak, A.W., Myers, J.B., Goodwin, I.A. & Hotaling, J.M. (2019). Fertility concerns of the transgender patient. Transl Androl Urol. 8 (3): 209-218. [Link]

  • While long-term study is lacking, one case study suggests that tucking can affect fertility. Expand
    While long-term study is lacking, one case study suggests that tucking can affect fertility.

    In a case study [1] of one transwoman, tucking resulted in oligospermia – an abnormally low sperm count – affecting fertility. Elevation of the testes because of tucking may contribute to heat stress and consequent impairment of spermatogenesis.

    After cessation of tucking and the provision of a new sperm sample, the sperm count in the patient was improved, and the semen had increased opacification.

    A further study [2] found that tucking could create a suboptimal environment for spermatogenesis.

    REFERENCES

    [1] Trussler, J. T., & Carrasquillo, R. J. (2020). Cryptozoospermia Associated With Genital Tucking Behavior in a Transwoman. Reviews in urology, 22 (4), 170–173. [Link]

    [2] Debarbo, C.J.M. (2020). Rare cause of testicular torsion in a transwoman: A case report. Urology Case Reports 33. [Link]