Prior testosterone use does not impact egg freezing outcomes for transgender men

Key takeaways:

• Egg freezing outcomes did not differ between transgender men who did or did not use prior testosterone therapy.
• More data are needed on embryologic and pregnancy outcomes for oocytes after testosterone exposure.

DENVER — Exposure to testosterone therapy did not impact outcomes related to egg freezing for transgender men who sought fertility preservation treatment, researchers reported.

Approximately 1.6 million people in the U.S. aged 13 years and older identify as transgender and 40% report that they desire biological children; however, the effects of testosterone therapy on fertility outcomes for transgender men are unclear, Natasha Raj-Derouin, MD, MS, a resident with Kaiser Permanente Los Angeles Medical Center, said during a presentation at the ASRM Scientific Congress & Expo. Additionally, there is increased interest in fertility preservation treatment after the passage of California Senate Bill 600, which requires coverage for medically necessary expenses for standard fertility preservation services when a medically necessary treatment, including gender-affirming therapies, directly or indirectly causes iatrogenic infertility.

“A large contributor to the limited amount of research in this field is limited access to care for transgender patients as well as the ability to afford fertility preservation; however, we are seeing changes with the passing of new laws that expand access to infertility treatments through insurance coverage,” Raj-Derouin said. “With the passing of California Senate Bill 600, our organization saw significant uptick in the number of transgender patients seeking fertility preservation. This prompted us to study deeper the effects of gender-affirming hormone therapy, such as testosterone, on fertility.”

Researchers conducted a retrospective study of 50 transgender and gender-diverse patients assigned female at birth who were referred for fertility preservation from 2012 to March 2024 and had complete data collection from 10 medical centers within the Kaiser Permanente Southern California region.

“It is worth noting that prior to 2020, when the Senate bill was passed, there were only 24 fertility preservation referrals placed vs. 411 referrals after the bill passed,” Raj-Derouin said.

Primary outcome was the number of mature oocytes collected. Secondary outcomes included peak estradiol level during ovarian stimulation, total dose of gonadotropins used during stimulation, percentage of mature oocytes to total oocytes and total oocyte yield.

Within the cohort, 16 patients had any prior testosterone therapy exposure (mean age, 25 years) and 34 patients had no testosterone exposure (mean age, 22 years). Among testosterone users, mean duration on therapy was 4.1 years, with the longest observed duration being 10 years. Testosterone was discontinued between 3 weeks and 3 months before cycle start.

At baseline, ovarian reserve markers, including antral follicle count, anti-Mullerian hormone level and endometrial lining (measured in millimeters) did not differ between users and nonusers of testosterone.

There were also no between-group differences in secondary cycle characteristics, including total gonadotropins used during stimulation and peak estradiol levels during stimulation.

Among patients with vs. no prior testosterone use, researchers found no between-group differences in the number of total oocytes retrieved (mean, 17.3 vs. 21.3; P = .2), the number of mature oocytes retrieved (mean, 12 vs. 16.1; P = .1) and the ratio of mature oocytes to total oocytes (72.3% vs. 70.9%; P = .81).

Raj-Derouin noted that data are limited on the reproductive potential of the cryopreserved oocytes.

“We need to evaluate embryologic and pregnancy outcomes from the oocytes retrieved after testosterone exposure and figure out ways to better guide and counsel young adolescent patients on fertility preservation in relation to gender-affirming hormone initiation,” Raj-Derouin said.

Reference:

• California Legislative Information. California Senate Bill No. 600. https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201920200SB600. Accessed Oct. 21, 2024.