Fertility preservation in a transgender man without prolonged discontinuation of testosterone: a case report and literature review

Case Reports

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Volume 1, Issue 1, Pages 43–47

Authors:

Kristy Cho, M.D., Rahana Harjee, M.D., Jeffrey Roberts, M.D., Caitlin Dunne, M.D.

Abstract:

Objective

To study the feasibility of fertility preservation in a transgender man without an extended period of androgen cessation.

Design

Report of a foundational case of oocyte cryopreservation in a transgender man without stopping testosterone therapy before controlled ovarian stimulation. We performed a literature review, identifying five publications on oocyte cryopreservation outcomes in transgender men on testosterone.

Setting

A university-affiliated fertility clinic in Canada.

Patient(s)

A 28-year-old transgender man taking testosterone for 3 years requesting oocyte cryopreservation before gender-affirming surgery. He desired to proceed without stopping testosterone. Pretreatment antimüllerian hormone level was 1.89 ng/mL. The patient’s consent was obtained for written publication.

Intervention(s)

Testosterone was stopped for only three doses (immediately before and during ovarian stimulation). A standard antagonist protocol was used with letrozole to minimize estrogenic side effects.

Main Outcome Measure(s)

Number of oocytes retrieved and days off testosterone.

Result(s)

Thirteen oocytes were retrieved; 11 were mature and vitrified. The total time off testosterone was 24 days. In all prior publications, testosterone was stopped for 3–6 months.

Conclusion(s)

Transgender men have traditionally discontinued exogenous testosterone until the resumption of menses (≤6 months). This is known to be distressing. This is the first published case demonstrating the feasibility of ovarian stimulation without prolonged testosterone cessation in a transgender man. Future studies with a larger sample size should be performed to confirm these findings. The short duration off testosterone may improve patient’s experiences, increase treatment acceptability, and decrease gender dysphoria for transgender men considering fertility preservation.

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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

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