This study sought to replicate and expand a previous pilot investigation of reproductive knowledge, attitudes toward fertility and parenthood, and sources of information on these topics among transgender and gender-expansive (TGE) youth.
Methods:
The Yale Pediatric Gender Program (YPGP) Reproductive Knowledge and Experiences Survey (YPGP-RKES) was administered to 70 TGE adolescents receiving care at an interdisciplinary clinic providing gender-affirming health care at an academic medical center. Data gathered included sources of information on reproduction and fertility, concerns about future parenthood and reproduction, and interest in different types of parenthood.
Results:
Over a third (39.1%) of participants reported it was important to them to have a child one day, while only a small proportion (23.2%) reported an interest in biological parenthood. A plurality of participants (37.3%) reported at least one concern about future fertility. The number of reproductive concerns did not differ by age or treatment (puberty blockers or gender-affirming hormones vs. no treatment) status. With respect to needs for more information and sources of information, most (56.5%) participants received information about fertility issues before this study, with the most cited source of information being online research.
Conclusions:
The current study replicated and extended previous findings on the reproductive attitudes and knowledge of TGE adolescents. Understanding the informational needs and priorities of adolescent TGE patients presenting for medical treatment will allow providers to give more robust patient education. This will, in turn, facilitate patients' ability to provide fully informed consent for treatment that aligns with their fertility and reproductive priorities and goals.
Get full access to this article
View all access options for this article.
References
1.
JohnsMM, LowryR, AndrzejewskiJ, et al.Transgender identity and experiences of violence victimization, substance use, suicide risk, and sexual risk behaviors among high school students—19 states and large urban school districts, 2017. MMWR Morb Mortal Wkly Rep. 2019; 68:67–71.
2.
MeerwijkEL, SeveliusJM. Transgender population size in the United States: a meta-regression of population-based probability samples. Am J Public Health. 2017; 107:e1–e8.
3.
ColemanE, BocktingW, BotzerM, et al.Standards of care for the health of transsexual, transgender, and gender-nonconforming people, Version 7. Int J Transgend. 2012; 13:165–232.
4.
HembreeWC, Cohen-KettenisPT, GoorenL, et al.Endocrine treatment of gender-dysphoric/gender-incongruent persons: an Endocrine Society* Clinical Practice Guideline. J Clin Endocrinol Metab. 2017; 102:3869–3903.
5.
UngerCA.Hormone therapy for transgender patients. Transl Androl Urol. 2016; 5:877–884.
6.
ConnollyMD, ZervosMJ, BaroneCJ, et al.The mental health of transgender youth: advances in understanding. J Adolesc Health. 2016; 59:489–495.
7.
de VriesALC, McGuireJK, SteensmaTD, et al.Young adult psychological outcome after puberty suppression and gender reassignment. Pediatrics. 2014; 134:696–704.
8.
Becerra-CulquiTA, LiuY, NashR, et al.Mental health of transgender and gender nonconforming youth compared with their peers. Pediatrics. 2018; 141:e20173845.
9.
ReisnerSL, VettersR, LeclercM, et al.Mental health of transgender youth in care at an adolescent urban community health center: a matched retrospective Cohort Study. J Adolesc Health. 2015; 56:274–279.
10.
AchilleC, TaggartT, EatonNR, et al.Longitudinal impact of gender-affirming endocrine intervention on the mental health and well-being of transgender youths: preliminary results. Int J Pediatr Endocrinol. 2020; 2020:8.
11.
MuradMH, ElaminMB, GarciaMZ, et al.Hormonal therapy and sex reassignment: a systematic review and meta-analysis of quality of life and psychosocial outcomes. Clin Endocrinol (Oxf). 2010; 72:214–231.
12.
White HughtoJM, ReisnerSL. A systematic review of the effects of hormone therapy on psychological functioning and quality of life in transgender individuals. Transgend Health. 2016; 1:21–31.
13.
KuperLE, StewartS, PrestonS, et al.Body dissatisfaction and mental health outcomes of youth on gender-affirming hormone therapy. Pediatrics. 2020; 145:e20193006.
14.
AlmazanAN, KeuroghlianAS. Association between gender-affirming surgeries and mental health outcomes. JAMA Surg. 2021; 156:611–618.
15.
LübbertH, Leo-RoßbergI, HammersteinJ. Effects of ethinyl estradiol on semen quality and various hormonal parameters in a eugonadal male. Fertil Steril. 1992; 58:603–608.
16.
SchulzeC.Response of the human testis to long-term estrogen treatment: morphology of Sertoli cells, Leydig cells and spermatogonial stem cells. Cell Tissue Res. 1988; 251:31–43.
17.
IkedaK, BabaT, NoguchiH, et al.Excessive androgen exposure in female-to-male transsexual persons of reproductive age induces hyperplasia of the ovarian cortex and stroma but not polycystic ovary morphology. Hum Reprod. 2013; 28:453–461.
18.
FutterweitW, DeligdischL. Histopathological effects of exogenously administered testosterone in 19 female to male transsexuals. J Clin Endocrinol Metab. 1986; 62:16–21.
19.
BaramS, MyersSA, YeeS, LibrachCL. Fertility preservation for transgender adolescents and young adults: a systematic review. Hum Reprod Update. 2019; 25:694–716.
20.
NeblettMF, HippHS. Fertility considerations in transgender persons. Endocrinol Metab Clin North Am. 2019; 48:391–402.
21.
ChiniaraLN, VinerC, PalmertM, BonifacioH. Perspectives on fertility preservation and parenthood among transgender youth and their parents. Arch Dis Child. 2019; 104:739–744.
22.
MorrisonA, OlezeskiC, CronJ, KallenAN. A pilot study to assess attitudes toward future fertility and parenthood in transgender and gender expansive adolescents. Transgend Health. 2020; 5:129–137.
23.
PerskyRW, GruschowSM, SinaiiN, et al.Attitudes toward fertility preservation among transgender youth and their parents. J Adolesc Health. 2020; 67:583–589.
24.
StrangJF, JarinJ, CallD, et al.Transgender youth fertility attitudes questionnaire: measure development in nonautistic and autistic transgender youth and their parents. J Adolesc Health. 2018; 62:128–135.
25.
LangerMD, SilverEJ, DodsonNA, et al.Fertility desires of adolescent females: decreased desire for children in those identifying as transgender/gender diverse and in depressed adolescents. J Pediatr Adolesc Gynecol. 2020; 33:703–707.
26.
ChenD, SimonsL, JohnsonEK, et al.Fertility preservation for transgender adolescents. J Adolesc Health. 2017; 61:120–123.
27.
StrangJF, ChenD, NelsonE, et al.Transgender youth executive functioning: relationships with anxiety symptoms, autism spectrum disorder, and gender-affirming medical treatment status. Child Psychiatry Hum Dev. 2021 [Epub ahead of print]; DOI:10.1007/s10578-021-01195-6.
28.
WierckxK, StuyverI, WeyersS, et al.Sperm freezing in transsexual women. Arch Sex Behav. 2012; 41:1069–1071.
29.
WierckxK, Van CaenegemE, PenningsG, et al.Reproductive wish in transsexual men. Hum Reprod. 2012; 27:483–487.
30.
De SutterP, KiraK, VerschoorA, HotimskyA. The desire to have children and the preservation of fertility in transsexual women: a survey. Int J Transgend. 2002; 6.
31.
KimJ, DealAM, BalthazarU, et al.Fertility preservation consultation for women with cancer: are we helping patients make high-quality decisions?. Reprod Biomed Online. 2013; 27:96–103.
32.
BalthazarU, DealAM, FritzMA, et al.The current fertility preservation consultation model: are we adequately informing cancer patients of their options?. Hum Reprod. 2012; 27:2413–2419.
33.
GormanJR, SuHI, PierceJP, et al.A multidimensional scale to measure the reproductive concerns of young adult female cancer survivors. J Cancer Surviv. 2014; 8:218–228.
34.
BenedictC, ThomB, FriedmanDN, et al.Young adult female cancer survivors' unmet information needs and reproductive concerns contribute to decisional conflict regarding posttreatment fertility preservation: decisions about future fertility preservation. Cancer. 2016; 122:2101–2109.
ChenD, MatsonM, MacapagalK, et al.Attitudes toward fertility and reproductive health among transgender and gender-nonconforming adolescents. J Adolesc Health. 2018; 63:62–68.
37.
KywelukMA, SajwaniA, ChenD. Freezing for the future: transgender youth respond to medical fertility preservation. Int J Transgend. 2018; 19:401–416.
DonaldsonAA, LindbergLD, EllenJM, MarcellAV. Receipt of sexual health information from parents, teachers, and healthcare providers by sexually experiencedU.S. adolescents. J Adolesc Health. 2013; 53:235–240.
41.
HolstromAM.Sexuality education goes viral: what we know about online sexual health information. Am J Sex Educ. 2015; 10:277–294.
42.
ClarkBA, VealeJF, TownsendM, et al.Non-binary youth: access to gender-affirming primary health care. Int J Transgend. 2018; 19:158–169.
43.
RiggsDW, BartholomaeusC. Fertility preservation decision making amongst Australian transgender and non-binary adults. Reprod Health. 2018; 15:181.
44.
von DoussaH, PowerJ, RiggsD. Imagining parenthood: the possibilities and experiences of parenthood among transgender people. Cult Health Sex. 2015; 17:1119–1131.
45.
TaskerF, GatoJ. Gender identity and future thinking about parenthood: a qualitative analysis of focus group data with transgender and non-binary people in the United Kingdom. Front Psychol. 2020; 11:865.
46.
HoffklingA, Obedin-MaliverJ, SeveliusJ. From erasure to opportunity: a qualitative study of the experiences of transgender men around pregnancy and recommendations for providers. BMC Pregnancy Childbirth. 2017; 17(S2):332.
47.
VoultsosP, ZymvragouCE, KarakasiMV, PavlidisP. A qualitative study examining transgender people's attitudes towards having a child to whom they are genetically related and pursuing fertility treatments in Greece. BMC Public Health. 2021; 21:378.
48.
Pullen SansfaçonA, Temple-NewhookJ, Suerich-GulickF, et al.The experiences of gender diverse and trans children and youth considering and initiating medical interventions in Canadian gender-affirming speciality clinics. Int J Transgend. 2019; 20:371–387.
49.
QuainKM, KywelukMA, SajwaniA, et al.Timing and delivery of fertility preservation information to transgender adolescents, young adults, and their parents. J Adolesc Health. 2021; 68:619–622.
50.
KermanHM, PhamA, CrouchJM, et al.Gender diverse youth on fertility and future family: a qualitative analysis. J Adolesc Health. 2021; 68:1112–1120.
51.
ChenD, KywelukMA, SajwaniA, et al.Factors affecting fertility decision-making among transgender adolescents and young adults. LGBT Health. 2019; 6:107–115.
52.
KolbuckVD, SajwaniA, KywelukMA, et al.Formative development of a fertility decision aid for transgender adolescents and young adults: a multidisciplinary Delphi consensus study. J Assist Reprod Genet. 2020; 37:2805–2816.
53.
Equality Maps: Foster and Adoption Laws. Movement Advancement Project. Available at: www.lgbtmap.org/equality-maps/foster_and_adoption_laws Accessed December12, 2021.
54.
FarrRH, GoldbergAE. Sexual orientation, gender identity, and adoption law: sexual orientation, gender identity, adoption law. Fam Court Rev. 2018; 56:374–383.
55.
GoldbergAE, TornelloS, FarrR, et al.Barriers to adoption and foster care and openness to child characteristics among transgender adults. Child Youth Serv Rev. 2020; 109:104699.
56.
BrikT, VrouenraetsLJJJ, SchagenSEE, et al.Use of fertility preservation among a cohort of transgirls in the Netherlands. J Adolesc Health. 2019; 64:589–593.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
