Few transgender teens and parents willing to delay hormone therapy to preserve fertility

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Credit: Pediatric Academic Societies

TORONTO, May 5, 2018 – Research on transgender teens' and their parents' attitudes regarding fertility preservation will be presented during the Pediatric Academic Societies (PAS) 2018 Meeting in Toronto. A new study found that while more research is needed on the subject, fertility preservation is a major factor for only a minority of transgender teens and their parents in deciding to delay hormone therapy.

Fertility preservation is an important issue to address with transgender and gender non-conforming youth and their families, prior to undergoing hormone therapy. However, little is known about transgender teens' and their parents' attitudes on fertility preservation.

The authors surveyed 66 youth and 52 parents of youth receiving gender-affirming medical care at Children's Hospital of Philadelphia's Gender and Sexuality Development Clinic. The average age of youth participating in the study was 16 and the majority (63 percent) was assigned female sex at birth. Surveys were administered electronically and contained 36 items about knowledge of fertility preservation, desire to have biologic children and other factors that may influence the decision to pursue fertility preservation.

"While hormone therapy has drastically improved the lives of countless transgender and gender non-conforming youth, its impact on fertility can unfairly force individuals to decide at a very early age whether or not they should preserve the ability to be a biological parent one day," said Rebecca Persky, MD, former Children's Hospital of Philadelphia resident, and lead author on the study. Dr. Persky now is a pediatric endocrinology fellow at the Eunice Kennedy Shriver National Institute of Child Health and Human Development, part of the National Institutes of Health. "These are difficult conversations for physicians to have with youth and families, and we hope our findings on how adolescents and parents approach these decisions will ultimately help providers counsel patients on hormone therapy with their fertility desires in mind."

While the majority of youth and parents were not willing to delay therapy to preserve biologic fertility, parents were significantly more likely to be willing to delay treatment and cited wanting more information as a major factor.

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Dr. Persky will present the abstract, "Attitudes Towards Fertility Preservation Among Transgender Youth and Their Parents," during the PAS 2018 Meeting on Monday, May 7 at 10:30 a.m. EDT. Reporters interested in an interview with Dr. Persky should contact [email protected]

Please note: Only the abstract is being presented at the meeting. In some cases, the researcher may have additional data to share with media.

The PAS 2018 Meeting, taking place in Toronto on May 5-8, 2018, brings together thousands of pediatric scientists and other health care providers to improve the health and well-being of children worldwide. For more information about the PAS 2018 Meeting, please visit http://www.pas-meeting.org.

About The Pediatric Academic Societies (PAS) Meeting

The Pediatric Academic Societies (PAS) Meeting brings together thousands of pediatricians and other health care providers united by a common mission: improve the health and well-being of children worldwide. This international gathering includes researchers, academics, as well as clinical care providers and community practitioners. Presentations cover issues of interest to generalists as well as topics critical to a wide array of specialty and sub-specialty areas. The PAS Meeting is produced through a partnership of four pediatric organizations that are leaders in the advancement of pediatric research and child advocacy: American Pediatric Society, Society for Pediatric Research, Academic Pediatric Association and American Academy of Pediatrics. For more information, please visit http://www.pas-meeting.org. Follow us on Twitter @PASMeeting and #PAS2018, or like us on Facebook.

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Abstract: Attitudes Towards Fertility Preservation Among Transgender Youth and Their Parents

Background: Fertility preservation (FP) is an important issue to address with transgender and gender non-conforming (T/GNC) youth and their families prior to starting gender-affirming hormones. However, little is known about transgender youths' and their parents' attitudes about FP.

Objective: To better understand attitudes of T/GNC youth and their parents about fertility preservation.

Design/Methods: Between January 2017 and December 2017, we conducted a cross-sectional survey of T/GNC youth and their parents who obtained medical care at a pediatric hospital-based clinic for T/GNC youth. Surveys were administered electronically and contained 36 items about knowledge of FP, desire to have biologic children, and other factors that may influence their decision to pursue FP procedures. Logistic regression was used to examine the relationship between willingness to delay treatment preserve fertility, desire to have biologic children, and demographic factors.

Results: Sixty-six youth and 52 parents completed the survey. Youth participants were mean age 16 and majority (63%) assigned female sex at birth. Parents were mean age 48. Only 20% of youth and 11.5% of parents found it important to have biologic offspring, and for youth, importance of having biologic children was associated with perceiving it as important to their parents (OR = 6.07 9% CI: 1.28, 28.7). Very few youth (4.5%) agreed they would be willing to delay hormone treatment to undergo FP, but for those who did, the importance of having biologic children was the most important predictor (OR: 6.76, 95% CI: 6.53, 6.99). Lack of information about whether hormone therapy definitely prevents biologic fertility was associated with parent willingness to delay treatment for FP (OR: 24.57, 95% CI: 3.9, 154.15). Further, 70% of youth agreed that discomfort with a part of the body they don't identify with was a factor that influenced their decision to undergo FP. Religious, financial, ethical, and demographic factors were not associated with willingness to delay treatment for FP.

Conclusion(s): While the majority of transgender youth and their parents did not find it important to have biologic offspring and would not be willing to delay starting hormone therapy to pursue FP, parental concern about uncertainty of effect on biologic fertility was associated with willingness to delay treatment. More qualitative research is needed to understand youth and parent decisions regarding FP.

Authors: Rebecca Persky, Siobhan Gruschow, Claire Carlson, Jill Ginsberg, Nadia Dowshen

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