Department of Pediatrics, Division of Endocrinology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
M-Care Healthcare, Witchita, KS, USA.
J Pediatr Urol. 2023 Oct;19(5):540.e1-540.e5. doi: 10.1016/j.jpurol.2023.02.006. Epub 2023 Feb 15.
Fertility preservation (FP) is an important aspect of the care of transgender patients in whom Gender Affirming Medical Treatment (GAT) may begin before puberty is completed. While there are overall few studies that can be used to guide conversations about long-term effects of GAT, there are concerns that GAT could negatively impact fertility. Prior studies have shown low utilization of FP in this population, with avoidance of delay in starting GAT cited as one of the most common reasons for foregoing FP. It is possible that strategies to mitigate delay in commencement of GAT can facilitate higher FP utilization, maintaining options for future family building.
To describe our institution's experience with Testicular Sperm Extraction (TESE) for FP and Histrelin Acetate (Supprelin) Subcutaneous Implantation for GAT commencement.
A retrospective review of transfeminine adolescents at our institution from 2010 to 2022 who underwent TESE for FP at the time of Supprelin placement for GAT (FP/SP). Outcomes of interest included successful sperm retrieval, age at first visit to our institution's Transgender Multispecialty Service Health clinic (GeMS), age at time of FP/SP, testicular volume, and Tanner stage at time of FP/SP, and age when GnRH agonist (GnRHa) therapy was prescribed. Testosterone, LH, FSH, and Inhibin B values prior to combination FP/SP were also obtained.
Ten patients from 2017 to 2022 underwent FP/SP after prescription of GnRHa based on Endocrine Society Guidelines. Successful sperm retrieval and storage was achieved in all patients. Median age at FP/SP was fourteen years 5.5 months (range 12y5m-16y8m). Median time from GnRHa prescription to FP/SP was two months (range 2-5 m). Mean testicular volume at time of FP/SP was 13.2 cc (SD 3.38 cc, range 8-17 cc), and median Tanner Stage was IV (range III-V). Average testosterone level was 301.60 (SD 173.04), LH 3.00 (SD 1.25), FSH 3.33 (SD 1.71), Inhibin B 208.50 (SD 87.44).
Performing TESE for FP is feasible for transgender youth undergoing Histrelin implant placement, leading to short delays in starting GAT. Testicular volume and endocrine markers can provide preoperative insight into likelihood of successful sperm retrieval during TESE, are needed to identify which patients will have successful sperm retrieval to ensure optimal counseling and informed decision making for providers, patients and families.
生育力保存（FP）是跨性别患者护理的一个重要方面，在这些患者中，性别肯定治疗（GAT）可能在青春期完成之前开始。虽然很少有研究可以用来指导关于 GAT 的长期影响的讨论，但有人担心 GAT 可能会对生育能力产生负面影响。先前的研究表明，该人群中 FP 的利用率较低，避免延迟开始 GAT 被认为是放弃 FP 的最常见原因之一。减轻 GAT 开始延迟的策略可能会促进更高的 FP 利用率，为未来的家庭建设保留选择。
描述我们机构在使用曲普瑞林醋酸酯（Supprelin）皮下植入进行 GAT 开始时进行睾丸精子提取（TESE）进行 FP 的经验。
对 2010 年至 2022 年在我们机构接受 TESE 进行 FP 的跨性别青少年进行回顾性研究，这些青少年在 Supprelin 放置时进行了 GAT（FP/SP）。感兴趣的结果包括成功获取精子、首次到我们机构的跨性别多专科服务健康诊所（GeMS）就诊的年龄、进行 FP/SP 的年龄、睾丸体积和 FP/SP 时的 Tanner 阶段，以及 GnRH 激动剂（GnRHa）治疗开始时的年龄。还获得了 FP/SP 前的睾酮、LH、FSH 和抑制素 B 值。
根据内分泌学会指南，2017 年至 2022 年期间，有 10 名患者在开具 GnRHa 后接受了 FP/SP。所有患者均成功获取并储存精子。FP/SP 的中位年龄为 14 岁 5.5 个月（范围 12y5m-16y8m）。从 GnRHa 处方到 FP/SP 的中位时间为 2 个月（范围 2-5m）。FP/SP 时的平均睾丸体积为 13.2cc（SD 3.38cc，范围 8-17cc），中位 Tanner 阶段为 IV（范围 III-V）。平均睾酮水平为 301.60（SD 173.04），LH 3.00（SD 1.25），FSH 3.33（SD 1.71），抑制素 B 208.50（SD 87.44）。
对于接受 Histrelin 植入物放置的跨性别青年，进行 TESE 进行 FP 是可行的，这导致 GAT 开始的延迟很短。睾丸体积和内分泌标志物可以提供术前关于 TESE 期间成功获取精子的可能性的信息，对于识别哪些患者将成功获取精子以确保提供者、患者和家属进行最佳咨询和知情决策是必要的。
