(42) Fertility intentions among transgender and non-binary youth

Background: Transgender and non-binary individuals may experience gender dysphoria, distress associated with the incongruence between one’s gender identity and sex assigned at birth. Gender-affirming treatments are used to alleviate gender dysphoria by facilitating physical changes more closely aligned with one’s gender identity but may affect fertility. Research investigating the fertility intentions of transgender and non-binary adolescents is limited, with no studies of non-binary youth. Our objective was to assess fertility intentions and future parenting goals in a cohort of gender diverse adolescents seen in a multidisciplinary pediatric gender program and assess how those goals differ by gender identity.

Methods: This is a retrospective chart review of all gender diverse patients who were seen at the Nemours Gender Wellness Program from 2015-2020. Abstracted data include patient demographics, fertility intentions, referrals, and procedures. Descriptive statistical analysis was performed using frequency counts, percentages, medians and standard deviations. Comparisons were made between transgender and gender non-binary patients. Categorical variables were compared using chi-square and Fisher exact tests; continual variables were compared with t-tests or mann-whitney testing as appropriate for non-parametric variables.

Results: Of the 189 included patients, most were White (83%) and non-Hispanic (90%). Participant ages ranged from 5-18 years, with a median of 15.00 (SD 2.5) years. 168 (88%) individuals identified as transgender and 21 (11%) as non-binary. Of the participants that discussed fertility intention during their visit, more transgender adolescents were interested in future parenting than non-binary youth (35% vs. 20%, p=0.01). The majority of participants from both groups did not express any interest in current parenting (100%), future pregnancy (95%) or desire for biological children (59%). However, 31% of participants were interested in a Reproductive Endocrinology and Infertility consult and/or fertility preservation procedure, with no differences between groups.

Conclusions: Within our cohort, transgender individuals were more likely than non-binary individuals to express an interest in future parenting. Despite this, most patients in both groups were not interested in biological children or fertility preservation. Understanding fertility intentions among gender diverse adolescents can help inform counseling on gender-affirming care and improve treatment strategies for this population.