Fertility preservation in transgender men without discontinuation of testosterone

Objective: To report two cases of fertility preservation in two transgender men without an extended period of higher dose testosterone cessation. Design: Chart abstraction was completed for two cases of oocyte preservation in transgender men without stopping testosterone gender-affirming therapy before controlled ovarian stimulation (COS). Setting: A university-affiliated fertility clinic in San Francisco, California. Patient(s): Two 27-year-old transgender men on higher dose testosterone undergoing oocyte cryopreservation. Main Outcome Measure(s): Both patients had been on 6 and 20 months of testosterone therapy, respectively, and continued throughout COS. A random start antagonist plus letrozole protocol was used for the patient in case 1, with a leuprolide acetate trigger. A luteal start antagonist protocol was applied to the patient in case 2 with a leuprolide acetate trigger. Result(s): In case 1, a total of 35 oocytes were retrieved, with a total of 23 metaphase II (MII) oocytes cryopreserved. An additional 7 MII oocytes were obtained after in vitro maturation for a total of 30 MII oocytes that were vitrified. In case 2, 14 oocytes were retrieved, and Conclusion(s): Transgender men have historically been advised to discontinue testosterone before COS, a process that may be distressing for many individuals. This is the first published case report demonstrating the proof of concept of COS without cessation of highdose testosterone therapy in two transgender men. Future studies with larger sample sizes should be performed to confirm these findings. (Fertil Steril Rep (R) 2022;3:153-6. (c) 2022 by American Society for Reproductive Medicine.)