Place de la préservation de la fertilité dans le parcours de transition des femmes transgenres

International audienceThe evolution of medical care for transgender people currently makes it possible to propose fertility preservation. Fertility preservation should be initiated before the start of hormonal treatments and/or surgical procedures. The “reproductive” aspect and the desire for parenthood among transgender people have long been ignored. However, these aspects are important to consider and fertility preservation should be discussed before the start of the physical transition. The aim of this review is to assess the literature on fertility preservation for transgender women (“male to female”). Many uncertainties remain regarding the impact of hormonal treatments on the reproductive functions of transgender women and their reversibility. However, the significant increase in the number of recently published articles is evidence of the improvement in the conditions of access to these procedures for women starting a transition process. Nevertheless, there are still a number of barriers that can prevent or delay this process.L’évolution de l’accompagnement médical des personnes transgenres permet actuellement de proposer la mise en place de stratégies de préservation de la fertilité, idéalement avant l’instauration des traitements hormonaux et/ou actes chirurgicaux. La dimension « reproductive » et le désir de parentalité chez les personnes transgenres ont longtemps été ignorés. Ces aspects sont pourtant importants à considérer et des mesures de préservation de la fertilité doivent donc être discutées avant le démarrage du parcours médical de transition physique. Cette revue a pour objectif de réaliser un état des lieux de la littérature concernant la préservation de la fertilité des femmes transgenres (« male to female »). De nombreuses incertitudes persistent quant à l’impact des traitements hormonaux sur les fonctions de reproduction des femmes transgenres et leur réversibilité. Cependant, l’augmentation importante du nombre des articles récemment publiés témoigne de l’amélioration des conditions d’accès à ces procédures pour les femmes qui démarrent un parcours de transition. Il reste néanmoins un certain nombre de barrières qui peuvent empêcher ou retarder ce processus

Reproductive functions and fertility preservation in transgender women: a French case series

International audienceResearch questionThe reproductive potential of transgender people may be impaired by gender-affirming hormone treatment (GAHT) and is obviously suppressed by gender-affirming surgery involving bilateral orchiectomy. The evolution of medical support for transgender people has made fertility preservation strategies possible. Fertility preservation in transgender women mainly relies on sperm cryopreservation. There are few studies on this subject, and the sample sizes are small, and so it difficult to know whether fertility preservation procedures are feasible and effective in trans women.DesignThis retrospective study reports the management of fertility preservation in transgender women referred to the study centre for sperm cryopreservation, and the semen parameters of trans women were compared with those of sperm donors.ResultsNinety-six per cent of transgender women who had not started treatment benefitted from sperm cryopreservation, compared with 80% of those who attempted a therapeutic window and 50% of those receiving hormonal treatment at the time of sperm collection. No major impairment of semen parameters was observed in transgender women who had not started GAHT compared with sperm donors. However, even though the frequency of oligozoospermia was no different, two transgender women presented azoospermia. Some transgender women who had started GAHT could benefit from sperm freezing. None of them were treated with gonadotrophin-releasing hormone (GnRH) analogues.ConclusionsParenthood strategies for transgender people have long been ignored, but this is an important issue to consider, especially because medical treatments and surgeries may be undertaken in adolescents or very young adults. Fertility preservation should ideally be offered prior to initiation of GAHT