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Transgender fertility: producing viable sperm after stopping gender-affirming medications

Written by Lauren Woolfe

A case series has provided new insights into transgender fertility options for male to female patients, showing it is possible to regain sperm function after ceasing gender-affirming medication treatment.

Transgender surgery is becoming more and more common, especially in young adults, with an increase in LGBTQ+ rights and awareness leading to more transgender individuals seeking treatment. However, when deciding whether to undergo surgery, many transgender women aren’t of an age where parenthood is their top priority and often doctors do not provide effective information on sperm freezing before patients embark on gender-affirming hormone treatment. This has led to many individuals seeking help from fertility professionals later in life, yet there are no studies to guide clinicians when advising patients.

In order to overcome this issue, scientists from Magee-Womens Research Institute (MWRI; PA, USA) and  UPMC Children’s Hospital (PA, USA), have followed two young transgender women who attempted to recover fertility after starting, and subsequently stopping, gender-affirming medications prior to surgery.

“We were interested in examining the timeline for getting viable sperm after stopping masculinity-suppressing medication,” commented lead author Hanna Valli-Pulaski (MWRI). “Going on and off gender-affirming medications can cause psychological distress in this population and it’s important patients have a discussion with their health care provider before starting or stopping any treatment.”

The first patient to be studied had been taking the sex hormone blocker Lupron for 6 months. Within 5 months of stopping this medication, she was able to produce a sperm sample comparable to those collected from the eight transgender women who saved their sperm prior to undergoing treatment.

However, this preservation is not universal; a second transgender woman who had been taking estradiol and spironolactone for more than 2 years could not produce viable sperm 4 months after stopping treatment.

This research is one of the first to show it is possible to regain sperm production after taking gender- affirming medications. That being said, a few months off these medications can deepen a transgender woman’s voice and increase facial hair growth, factors which can be psychologically damaging to patients.

It is important that more information is collected, allowing these women to understand all their options for future fertility. For those who have been on medications for longer periods, more research would be able to provide a time frame to which they would have to experience these effects. This would therefore inform their choice as to whether, or not, they would attempt to regain sperm function.

“Right now, there’s not much information available about fertility preservation for transgender patients,” Valli-Pulaski stated. “If you have any data, it’s important to share so that patients, researchers and clinicians can learn from it.”