New study on fertility treatment for trans men: Prior testosterone use does not affect ovarian stimulation outcomes

Disclaimer: I am not a medical professional and this is not medical advice.

There’s an abundance of misinformation among the public regarding cross-sex hormone therapy’s effects on fertility: many people seem to believe that taking HRT, even if later discontinued, will result in permanent infertility for trans people. This is far from the case – while, for instance, estrogen and antiandrogens can negatively affect fertility in AMABs, this is “highly variable” and some trans women have “qualitatively normal spermatogenesis” while on HRT (Schneider et al., 2017); Adeleye et al. (2017) also found that by an average of 4.7 months after discontinuing HRT, “normal semen parameters” were attained. Pregnancies occurring among trans men taking testosterone, including unintended pregnancies, have been documented extensively (Light et al., 2014). The belief that either feminizing or masculinizing HRT provide effective contraception is not only false, but potentially dangerous, placing trans people and their partners at risk of unplanned pregnancy.

A recent study provides further confirmation that HRT usage does not necessarily preclude fertility. Leung et al. (2019) examined the outcomes of 26 trans men seeking fertility treatment, 61% of whom had taken testosterone for an average of 3.7 years. These trans men discontinued testosterone for an average of 4 months before undergoing ovarian stimulation for the purpose of fertility preservation (cryopreservation of eggs or embryos) or uterine transfer of embryos. Notably, the protocols used for ovarian stimulation in trans men “were the same as those used for cisgender patients; there was no unique protocol specifically tailored for transgender patients.” Trans men were matched to cisgender women for comparison by age, BMI, and levels of anti-Müllerian hormone.

In each cycle of ovarian stimulation, the cis women in the study had an average of 15.9 eggs retrieved. Not only did trans men have just as many eggs retrieved – they had significantly more.

On average, more oocytes were retrieved in the transgender cycles compared with cisgender cycles, and this result was statistically significant (19.9 ± 8.7 vs. 15.9 ± 9.6; P = .04; Table 2). Number of mature oocytes and peak E2 levels were similar between the two groups; however, significantly higher total doses of gonadotropins were used in the transgender stimulation cycles (Table 2).

This trend held even when examining only the outcomes of those trans men who had previously used testosterone:

A subanalysis was performed on only the transgender patients who had initiated testosterone therapy (Table 3), which showed similar results. The exception was that although the number of oocytes retrieved from these transgender patients also trended higher, the difference was not statistically significant.

The authors added that among the trans men in this study, “all who transferred embryos eventually achieved a successful pregnancy and delivery.” Moreover, based on these results, they suggest it is worth investigating “whether ovarian stimulation can be done with any measure of success without the cessation of testosterone”, as the need to go off testosterone discourages many trans men from seeking fertility preservation. In other words, the results were about as far as possible from the myth that HRT permanently sterilizes trans people. ■