Egg freezing unaffected by testosterone exposure for gender-diverse teens, young adults

Key takeaways:

• Testosterone duration before egg retrieval was not tied to the number of mature oocytes frozen for exposed gender-diverse individuals.
• Number of oocytes retrieved was similar for exposed and nonexposed groups.

Prior testosterone exposure did not impact oocyte cryopreservation outcomes among transgender and gender-diverse adolescents and young adults, according to a research letter published in Obstetrics & Gynecology.

“Our findings highlight the increase in referrals and utilization of oocyte cryopreservation for transgender and gender-diverse individuals when state-wide insurance coverage mandates are enacted,” Sarah Capelouto Cromack, MD, reproductive endocrinology and infertility fellow in the department of obstetrics and gynecology at Northwestern University, told Healio. “Hopefully, this information will mobilize advocacy for expanded insurance mandates for fertility preservation across the United States.”

Cromack and colleagues conducted a retrospective cohort study with 93 transgender and gender-diverse adolescents and young adults referred for oocyte cryopreservation through the Northwestern formal fertility preservation program between 2014 and 2023. All participants using testosterone discontinued therapy at least 8 weeks before egg retrieval per current best practices. Participants underwent gonadotropin-releasing hormone antagonist protocols to stimulate ovarian follicles with transabdominal ultrasonography for monitoring. Clinicians retrieved oocytes 36 hours after trigger using transvaginal ultrasonographic guidance and oocyte vitrification.

Primary outcomes were number of oocytes retrieved and mature oocytes frozen.

Overall, 37 individuals pursued oocyte cryopreservation, of whom 31 were testosterone-naïve and six were testosterone-exposed before consultation for a median of 42 months. Individuals with testosterone exposure were older vs. testosterone-naïve individuals (mean age, 22.6 vs. 16.6 years; P < .01). All patients completed one cycle. A median of 21 mature oocytes were frozen, according to researchers.

Length of time on testosterone prior to presentation and duration of testosterone before oocyte retrieval were not associated with the number of mature oocytes frozen among transgender and gender-diverse adolescents and young adults who were exposed to testosterone. Researchers observed no difference in the number of oocytes retrieved from testosterone-naïve or testosterone-exposed individuals (median, 28 vs. 32) or mature oocytes frozen (21 vs. 21).

“Our study offers reassurance that fertility preservation can be performed effectively in transgender and gender-diverse individuals previously exposed to testosterone after a washout period of at least 2 months,” Cromack told Healio. “Moreover, there was no difference in number of oocytes retrieved or mature oocytes frozen when comparing testosterone-naive with testosterone-exposed individuals. Lastly, our findings demonstrate

reasonable mature oocyte yields among young transgender and gender-diverse patients, with results comparable to patients younger than age 35 years undergoing planned oocyte cryopreservation.”

Cromack highlighted the success of oocyte cryopreservation for multiple patients aged 15 years or younger, with the youngest patient being age 10 years.

“This shows that age alone should not be a factor in offering oocyte cryopreservation for interested patients once peripubertal,” Cromack said.

For more information:

Sarah Capelouto Cromack, MD, can be reached at sarah.capelouto@nm.org; X (Twitter): @Sarah_CromackMD.