Reproductive Counseling for Transgendered Men in Sweden

October 31, 2014

There is little research on preserving fertility in transgendered men. Research from Sweden provides some evidence on reproductive counseling in these patients.

In 2013, a law instituted in 1972 that required transgendered people in Sweden to undergo sterilization before they could have gender reassignment surgery was overturned. This change now allows for clinicians to offer ways for transgendered people to preserve their fertility prior to surgery. However, clinical evidence that would guide treatment decisions for transgendered men is currently lacking. A study in the October 21, 2014, issue of Fertility and Sterility presented at ASRM 2014 offers insight into how transgendered people transitioning from female to male might receive care, both physical and psychological, for fertility preservation.

Of the 9 transsexual men who were recruited for the study, 7 of them were given reproductive counseling. The age range for all the participants was between 19 and 35, and they were in various stages of gender reassignment. Two had not yet started testosterone therapy, 2 had undergone some surgery, and 4 had mastectomies. Six of the patients decided on oocyte vitrification and underwent hormonal stimulation, while 1 chose to have ovarian tissue retrieved and frozen during a scheduled hysterectomy with bilateral salpingo-oophorectomy (BSO).

All of the patients had hormone levels that were consistent with the normal range for females in their reproductive years. Patient compliance was a concern, and a drug protocol with letrozole was used with that aspect of treatment in mind. Approximately 13 eggs with an average maturity rate of 88% were retrieved and vitrified from each of the 6 patients in the study.

One psychological aspect of the reproductive counseling process was reported by the authors of the study. Patients reported dissatisfaction with the typical visual aids used during fertility preservation education, which are female forms. Instead, the men preferred the use of male forms with a "perception of presence of ovaries."

Because of potential ethical concerns with the study, the human ethics committee in Stockholm approved the research.