Patient Knowledge and Interest in Cryopreservation of Sperm in Patients Presenting for Male to Female Gender Affirming Surgery
Gender affirming surgery (GAS) in patients with gender dysphoria undergoing male to female transition leads to an irreversible loss of reproductive potential. Hormone therapy alters fertility potential in unclear ways. Current technology allows for cryopreservation of sperm prior to, or at the time of, GAS allowing for these patients to have biologic children. Little is known about reproductive knowledge and desires in this population. The objective of this study is to determine the knowledge and desire for cryopreservation of sperm for future reproduction in patients presenting for male to female GAS.
The electronic medical record (EMR) for patients presenting for male to female GAS from May 2015 to October 2017 at a gender affirming clinic were retrospectively reviewed. Basic demographic data, length of hormonal therapy, duration of dressing in most comfortable gender, presence of children, knowledge of cryopreservation, and desire for cryopreservation were all obtained.
Seventy-nine patients were identified. Average age was 34 years old (range 16-68 years). The mean duration of hormonal therapy was 5.6 years (range 1-27 years) and mean duration of dressing as female gender was 9.8 years (range 1-52 years). 9.6% of patients had at least one child at time of evaluation. 100% expressed understanding of the option for cryopreservation. 11.4% expressed definite or possible interest in cryopreservation of sperm for future reproduction. The average age of patients interested in cryopreservation was 26 years old, compared with 36 years old in those that were not interested in cryopreservation (p=0.044). The average duration of dressing in female gender was 8.4 years in patients interested in cryopreservation, compared with 9.8 years in those not interested (p=0.61). The average duration of hormone therapy was 6.9 years in patients interested in cryopreservation, compared with 5.4 years in those not interested (p=0.35). Patients who had children were less likely to be interested in cryopreservation (0% versus 10.9%), although this finding was not statistically significant (p=0.25)
Our data set shows that 100% of patients presenting for male to female gender affirming surgery were aware of the option for cryopreservation of sperm prior to, or at time of surgery, but only a minority (11.4%) of these patients were interested in pursuing this option for future reproduction at initial presentation for GAS surgery. Patients interested in biologic fertility options were younger compared to those not interested (p=0.04).