Gender-affirming hormone therapy: Effect on semen quality and use of fertility preservation

Fertility preservation (FP) is a fundamental part of gender care. Gender-affirming hormone therapy (GAHT) involves the use of drugs that could be potential risk factors for fertility. Therefore, FP is recommended before beginning the gender-affirmation process. This narrative review aims to assess several aspects, mainly concerning the assigned male at birth (AMAB) population. The purpose of this review is to provide an overview of the effects of GAHT on testicular morphology and seminal quality, the use of semen cryopreservation, the desire for parenthood among transgender people, the factors influencing the decision to use fertility preservation (FP) and suggestions for improving clinical practice. A literature search within PubMed was conducted and the results deal with issues such as changes in testicular morphology and semen quality, FP utilization, barriers to treatment, current clinical practice models, and suggestions for improving transgender adolescents access to FP. The results showed that GAHT can have a negative effect on fertility in transgender AMAB subjects. It is therefore recommended to carry out FP before starting such treatment. However, there is low percentage of utilization to FP among transgender adolescents. In deciding whether to pursue FP, they consider many factors: future parenting desires, individual experiences of gender dysphoria, family values around biological parenting, financial considerations, and the availability of fertility information. A discrepancy emerged between the rate of desire to become a parent and the actual rate of FP utilization. The reasons are various, such as cost, and concern in delaying the initiation of treatment. Suggestions for improving clinical practice are also provided from this literature search.