The following is a summary of “Interest In and Prior Receipt of Counseling on Fertility Preservation in Transgender Patients Presenting for Gender-affirming Orchiectomy,” published in the December 2023 issue of Urology by Sineath, et al.
For a study, researchers sought to describe the characteristics of patients seeking gender-affirming bilateral simple orchiectomy, including their interest in and prior education on reproductive options before gonad removal.
A retrospective chart review was conducted to assess patients undergoing gender-affirming bilateral orchiectomy. Data collected included patient age, family history, history of fertility preservation education before initiating gender-affirming hormone therapy, prior fertility preservation attempts, interest in fertility preservation, and post-orchiectomy surgical pathology results where applicable.
The study cohort comprised 78 patients. Notably, 22% (n = 17) reported that reproductive options were not discussed before their surgical consultation. Furthermore, 85% (n = 66) expressed no interest in fertility preservation. Reasons for this lack of interest included a disinterest in biological children (74%), a desire to avoid delaying transition (47%), and cost concerns (36%). Interestingly, patients who were married or in long-term relationships showed a higher interest in fertility preservation compared to those who were not in such relationships. Additionally, 40% of patients with available pathology data exhibited some degree of spermatogenesis in their testicular tissue.
The study highlighted a lower-than-expected rate of fertility preservation counseling before surgical referral. The deficiency in counseling may lead patients to forgo sperm banking before orchiectomy to avoid delaying their surgical care. Enhancing adherence to the WPATH guidelines could potentially increase interest in fertility preservation. The data also revealed a low utilization and interest in sperm preservation among transwomen and nonbinary patients undergoing bilateral simple orchiectomy at the institution. Early counseling regarding fertility preservation options during the transition could enhance the utilization of sperm cryopreservation.
Reference: goldjournal.net/article/S0090-4295(23)00657-X/abstract