de Nie Iris, Asseler Joyce, Meißner Andreas, Voorn-de Warem Ilona A C, Kostelijk E Hanna, den Heijer Martin, Huirne Judith, van Mello Norah M
Department of Endocrinology, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, The Netherlands; Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, The Netherlands; Reproduction & Development Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, The Netherlands; Reproduction & Development Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Department of Obstetrics and Gynecology, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, The Netherlands.
Am J Obstet Gynecol. 2022 Mar;226(3):390.e1-390.e10. doi: 10.1016/j.ajog.2021.10.020. Epub 2021 Oct 22.
Transgender women (people assigned male genders at birth with female gender identities) can choose to cryopreserve semen before their medical transition, to retain the possibility to parent genetically related offspring later in life. Our previous retrospective study showed that semen quality in transgender women was decreased compared with the general population. The etiology of this impaired semen quality remains largely unknown. However, impaired semen quality might be related to habitual behavior more typically observed in transgender women, for example, the desire to hide their testicles because of genital dysphoria. Therefore, we decided to conduct a consecutive study with prospectively obtained data on behavior and lifestyle in transgender women.
This study aimed to study the influence of a low ejaculation frequency, wearing tight undergarments, and bringing the testes in the inguinal position (tucking) on semen quality in transgender women at the time of fertility preservation.
In this cohort study, transgender women were included between May 2018 and September 2020, at the time of fertility counseling, before the start of hormonal treatment. Data were collected on demographics, lifestyle factors, medical history, endocrine laboratory results, and semen parameters. Semen parameters were categorized using reference values for human semen of the World Health Organization and compared with semen quality in the general population. The odds ratios with 95% confidence intervals were calculated using multivariable logistic regression analysis to assess the impact of tucking, wearing tight undergarments, and a low ejaculation frequency on semen quality, correcting for potential confounders.
Overall, 113 transgender women were included. Median semen parameters were significantly decreased than the general population. Crude logistic regression analyses showed an association between always wearing tight undergarments (odds ratio, 3.06; 95% confidence interval, 1.11-8.49) and extensive tucking (odds ratio, 6.09; 95% confidence interval, 1.54-24.01) on having a total motile sperm count of <5 million. Multivariable analyses showed that the association with tucking was independent of demographic factors, lifestyle factors, and medical history (odds ratio, 7.95; 95% confidence interval, 1.66-37.99). However, this was not the case for the association with always wearing tight undergarments (odds ratio, 2.89; 95% confidence interval, 0.95-8.82). Ejaculation frequency did not influence total motile sperm count.
Behavioral factors, including wearing tight undergarments and extensive tucking, may contribute to the lower semen quality in transgender women. These results will enable optimization of fertility counseling on how to adjust lifestyle before pursuing semen cryopreservation.
跨性别女性（出生时被指定为男性性别但具有女性性别认同的人）可以选择在医疗过渡前冷冻保存精液，以保留日后生育与自己有基因关系后代的可能性。我们之前的回顾性研究表明，与普通人群相比，跨性别女性的精液质量有所下降。这种精液质量受损的病因在很大程度上仍然未知。然而，精液质量受损可能与跨性别女性中更常见的习惯行为有关，例如，由于生殖器焦虑而想要隐藏睾丸。因此，我们决定进行一项连续性研究，前瞻性地获取跨性别女性的行为和生活方式数据。
本研究旨在探讨低射精频率、穿着紧身内衣以及将睾丸置于腹股沟位置（束腹）对跨性别女性在生育力保存时精液质量的影响。
在这项队列研究中，2018年5月至2020年9月期间，在生育咨询时、激素治疗开始前纳入跨性别女性。收集了人口统计学、生活方式因素、病史、内分泌实验室结果和精液参数的数据。精液参数根据世界卫生组织人类精液参考值进行分类，并与普通人群的精液质量进行比较。使用多变量逻辑回归分析计算95%置信区间的比值比，以评估束腹、穿着紧身内衣和低射精频率对精液质量的影响，并对潜在混杂因素进行校正。
总体而言，纳入了113名跨性别女性。精液参数中位数显著低于普通人群。粗略逻辑回归分析显示，总是穿着紧身内衣（比值比，3.06；95%置信区间，1.11 - 8.49）和广泛束腹（比值比，6.09；95%置信区间，1.54 - 24.01）与总活动精子数<500万之间存在关联。多变量分析表明，与束腹的关联独立于人口统计学因素、生活方式因素和病史（比值比，7.95；95%置信区间，1.66 - 37.99）。然而，与总是穿着紧身内衣的关联并非如此（比值比，2.89；95%置信区间，0.95 - 8.82）。射精频率不影响总活动精子数。
包括穿着紧身内衣和广泛束腹在内的行为因素可能导致跨性别女性精液质量较低。这些结果将有助于优化生育咨询，指导在进行精液冷冻保存前如何调整生活方式。
