Effects on Fertility and the Preservation of Fertility in the Transgender Patient

Purpose of Review Summarize the effects gender-affirming hormone therapy (GAHT) and gender-affirming surgical therapy (GAST) have on fertility of the transgender and gender diverse (TGD) patient as well as current clinical approaches in fertility preservation for transgender individuals. Recent Findings There are relatively limited data specific to fertility preservation for TGD individuals and current approaches to treatment are extrapolated from options for fertility preservation in cisgender individuals. Contemporary updates in this review include evolving research defining the reproductive potential of gametes that are exposed to pubertal suspension and GAHT in sequence, the persistent challenges of previously experimental ovarian tissue cryopreservation for TGD patients, and additional evidence that fertility can be largely conserved in TGD patients after testosterone use. Ultimately, several forms of fertility preservation options are available depending on the pubertal status of a transgender individual. Fertility treatment and preservation options should be discussed with transgender individuals regardless of stage of transition, but ideally before gender-affirming hormonal treatment or gonadectomy. Relatively few transgender individuals are seen for fertility care due to lack of provider awareness and patient perception of bias.