Background : Reproductive health needs of transgender individuals are often under addressed. The goal of this study is to determine the use of fertility preservation in this population and assess the reasons why many are not opting to preserve their fertility prior to hormone therapy.
Methods : Transgender individuals ages 18-64 participated in an online survey, which included questions about reproductive history and desire for fertility preservation.
Results : 989 transgender individuals completed the survey. 207 individuals identified on the transfeminine spectrum. The mean age was 34 (SD 14). 180 (87%) were white, and 190 (92%) had a college degree. 130 (63%) individuals had private health insurance, and 109 (52%) made less than 24,000/year. 150 (73%) were currently on hormone therapy. Of those, 62 (41%) desired children. 21 (14%) participants had preserved their fertility prior to starting hormone therapy. Reasons for not preserving fertility included cost (36%), no desire (60%), and unsure at the time they were asked (16%). 18 (13 %) were never presented with the option, while 20 (14%) already had children. 781 individuals identified on the transmasculine spectrum. The mean age was 27 (SD 8.6). 663 (85%) were white, and 344 (44%) had a college degree. 530 had private insurance (68%), and 413 (53%) made less than $24,000/year. 468 (60%) were on hormone therapy. Of those, only 3 (0.4%) had preserved their fertility prior to starting hormones. 266 (35%) desired children. Reasons for not preserving fertility included cost (31%), no desire (67%), and never being presented with the option (28%). 59 (11%) were unsure at the time they were asked. 6 (1%) already had children. 50 (7%) desired to personally carry a pregnancy, while 67 (9%) were unsure.
Conclusions : Very few individuals preserved their fertility prior to hormone therapy with the majority reporting cost and no desire as contributing factors. It was also noted that more individuals on the transmasculine spectrum were not presented with the option to preserve their fertility. These findings highlight the need for greater access to care for fertility preservation services. Provider education is also necessary to ensure individuals are being offered all of their options.