Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, Rochester, MN.
Department of Biomedical Ethics, Mayo Clinic, Rochester, MN.
Mayo Clin Proc. 2020 Apr;95(4):784-792. doi: 10.1016/j.mayocp.2019.10.040. Epub 2020 Feb 27.
Transgender individuals represent a small, albeit growing, patient population that is encountered more frequently in clinical care due to improved insurance coverage and increasing awareness. Gender-affirming treatments, including both gender-affirming hormone therapy and gender-affirming surgery, pose significant risks to fertility potential and outcomes, ranging from potentially impaired fertility rates to full elimination of reproductive potential depending on the type of treatment pursued. However, there are relatively limited data specific to fertility preservation for transgender individuals. Current approaches to treatment are extrapolated from options for fertility preservation after oncologic diagnoses. In this review, we aim to summarize current clinical approaches, fertility preservation options, and patient experiences in fertility preservation for transgender individuals. Several forms of fertility preservation options are available depending on the pubertal status of a transgender individual. Despite the multiple options for fertility preservation, major barriers exist to patient care and there are reports of mixed patient experiences. Further awareness of this clinical situation and understanding of these processes will allow for comprehensive and specialized care for transgender individuals who may otherwise miss opportunities for adequate counseling or treatment options regarding fertility preservation.
跨性别个体代表了一小部分但不断增长的患者群体，由于保险覆盖范围的扩大和意识的提高，他们在临床护理中越来越常见。性别肯定治疗，包括性别肯定激素治疗和性别肯定手术，对生育潜力和结果都存在重大风险，从潜在的生育能力受损到完全消除生殖潜力不等，具体取决于所追求的治疗类型。然而，针对跨性别个体的生育力保存，相关数据相对有限。目前的治疗方法是从肿瘤诊断后的生育力保存选择中推断出来的。在这篇综述中，我们旨在总结跨性别个体生育力保存的当前临床方法、生育力保存选择和患者体验。根据跨性别个体的青春期状态，有几种形式的生育力保存选择。尽管有多种生育力保存选择，但患者护理存在主要障碍，并且有报道称患者体验存在差异。进一步了解这种临床情况并理解这些过程，将为可能错过适当咨询或生育力保存治疗选择机会的跨性别个体提供全面和专业的护理。
