Department of Gynecological Endocrinology and Reproductive Medicine, Medical University; Innsbruck, Innsbruck, Austria.
Dtsch Arztebl Int. 2023 Apr 7;120(14):243-250. doi: 10.3238/arztebl.m2023.0026.
An increasing number of persons around the world are receiving the diagnosis of gender incongruence, and most of them are in their reproductive years. Safe contraception and fertility preservation are important issues for counseling.
This review is based on pertinent publications retrieved by a systematic search in the PubMed and Web of Science databases, employing the search terms "fertility," "contraception," "transgender," "gender-affirming hormone therapy" (GAHT), "ovarian reserve," and "testicular tissue." 908 studies were included, 26 of which entered the final analysis.
Most of the available studies on fertility in trans persons undergoing GAHT reveal a marked effect on spermatogenesis, but no impairment of ovarian reserve. No studies are available on trans women; the data show that 59-87% of trans men use contraceptives, often mainly in order to suppress menstrual bleeding. Fertility preservation measures are mainly used by trans women.
GAHT mainly impairs spermatogenesis; thus, counseling on fertility preservation should always be given before GAHT. More than 80% of trans men use contraceptives, mainly for their other effects such as suppression of menstrual bleeding. GAHT is not in itself a reliable method of contraception, and persons about to undergo GAHT should always receive contraceptive counseling.
世界上越来越多的人被诊断出性别不一致，其中大多数人处于生育年龄。安全避孕和生育力保存是咨询的重要问题。
本综述基于通过系统搜索 PubMed 和 Web of Science 数据库检索到的相关出版物，使用的检索词为“生育力”、“避孕”、“跨性别”、“性别肯定激素治疗（GAHT）”、“卵巢储备”和“睾丸组织”。共纳入 908 项研究，其中 26 项进入最终分析。
大多数接受 GAHT 的跨性别者生育力的研究表明，GAHT 对精子发生有明显影响，但对卵巢储备没有损害。没有关于跨性别女性的研究；数据显示，59-87%的跨性别男性使用避孕药具，通常主要是为了抑制月经出血。生育力保存措施主要用于跨性别女性。
GAHT 主要损害精子发生；因此，在 GAHT 之前应始终进行生育力保存咨询。超过 80%的跨性别男性使用避孕药具，主要是为了抑制月经出血等其他作用。GAHT 本身并不是一种可靠的避孕方法，即将接受 GAHT 的人应始终接受避孕咨询。
