Parikh Niki, Chattha Asma, Fredrickson Jolene R, Walker David, Zhao Yulian, Gargollo Patricio, Granberg Candace
Mayo Clinic Urology, Rochester, MN.
Mayo Clinic Division of Pediatric Gynecology, Rochester MN.
Urology. 2025 Jan;195:91-95. doi: 10.1016/j.urology.2024.08.020. Epub 2024 Aug 21.
To call to attention the often-overlooked aspect of pediatric transgender care: the importance of fertility preservation prior to instituting gender-affirming therapy. The transgender population has long been marginalized by society. Societal stigmata, fear to seek care, and dearth of provider knowledge regarding transgender health issues have caused disparities to widen. Gender-affirming procedures and hormone therapy affect the long-term reproductive potential of transgender individuals. While cost concerns and insurance coverage regarding oncofertility is a prominent area of discussion, the transgender community is often excluded.
Sixteen genetically XY females, followed by their multidisciplinary transgender care teams, were interested in starting hormone therapy due to impending onset and/or progression of puberty. Their physicians were aware of fertility struggles after undergoing hormone therapy and therefore referred to urology. Sperm cryopreservation via open gonadal biopsy, testicular tissue cryopreservation (TTC), and semen sample (when age/maturity-appropriate) were discussed. Though requiring surgery, biopsy/TTC relieves patients of the psychological impact of semen sample production.
Under IRB approval, 15 patients (median age 12 years, range 10-16 years) underwent TTC (Fig. 1). One patient (aged years) opted for semen sample. All patients had success with spermatogonial stem cells cryopreserved for future patient use.
With more individuals beginning medical and surgical therapy at a younger age, fertility preservation discussions are essential but often overlooked, depriving these individuals the joy of becoming a biological parent. TTC can be safely done in pediatric populations, though research is necessary to expand beyond current experimental stage of tissue development.
提醒人们关注儿科跨性别者医疗中一个常被忽视的方面：在开始性别确认治疗之前保留生育能力的重要性。跨性别群体长期以来一直被社会边缘化。社会的污名化、寻求治疗的恐惧以及医疗服务提供者对跨性别健康问题的知识匮乏导致差距不断扩大。性别确认手术和激素治疗会影响跨性别者的长期生殖潜力。虽然关于肿瘤生育力保存的成本问题和保险覆盖范围是一个突出的讨论领域，但跨性别群体往往被排除在外。
16名基因检测为XY的女性，在其多学科跨性别医疗团队的跟踪下，由于青春期即将开始和/或进展而对开始激素治疗感兴趣。她们的医生意识到接受激素治疗后生育方面的困难，因此转诊至泌尿外科。讨论了通过开放性性腺活检进行精子冷冻保存、睾丸组织冷冻保存（TTC）以及在年龄/成熟度合适时采集精液样本。虽然活检/TTC需要手术，但可减轻患者因采集精液样本而产生的心理影响。
在机构审查委员会（IRB）批准下，15名患者（中位年龄12岁，范围10 - 16岁）接受了TTC（图1）。一名患者（年龄 岁）选择了精液样本。所有患者的精原干细胞冷冻保存均成功，可供患者未来使用。
随着越来越多的人在更年轻的时候开始接受医学和手术治疗，保留生育能力的讨论至关重要，但往往被忽视，这剥夺了这些人成为亲生父母的喜悦。TTC在儿科人群中可以安全地进行，不过有必要开展研究，以超越目前组织发育的实验阶段。
