Amsterdam UMC, Location Vrije Universiteit Amsterdam, Centre of Expertise on Gender Dysphoria, Amsterdam University Medical Centres, De Boelelaan, The Netherlands.
Department of Obstetrics & Gynaecology, Amsterdam UMC, Amsterdam, The Netherlands.
Hum Reprod. 2024 Nov 1;39(11):2512-2524. doi: 10.1093/humrep/deae200.
How do transfeminine adolescents and their parents experience fertility preservation via testicular sperm extraction (TESE)?
Participants experienced the TESE process positively when provided with appropriate guidance to navigate the decisional dilemma between preserving future biological parenthood and the pressure to start puberty suppression early.
Sperm banking through ejaculation is not feasible for all transfeminine adolescents due to genital dysphoria and early puberty; for this group, TESE is the only alternative. However, during early puberty, they must postpone or pause puberty suppression until spermatogenesis is fully developed.
STUDY DESIGN, SIZE, DURATION: All consecutive TESE patients in our centre and their parents were invited to participate. Between December 2022 and May 2023, we included 6 adolescents and 10 parents. We used a qualitative approach based on semi-structured interviews to study the experience of the transfeminine adolescents and their parents.
PARTICIPANTS/MATERIALS, SETTING, METHODS: Transfeminine adolescents diagnosed with gender dysphoria in early puberty (Tanner stage ≥2) who underwent TESE before the start of puberty suppression or gender-affirming hormones participated in this study. The interviews were recorded, manually transcribed and analysed using reflective thematic analysis focusing on understanding the participants' experiences of puberty and fertility preservation and the various factors and social processes influencing their decision to undergo TESE.
Transfeminine adolescents decide to undergo invasive fertility preservation because of a possible, future desire for parenthood. Parents stressed the importance of preventing future decisional regret. They both saw masturbation to obtain a semen sample as unreachable. Even though TESE is a surgical procedure with possible complications and pain afterwards, this alternative seemed less dysphoric to them.Adolescents had to postpone the start of puberty suppression, waiting for spermatogenesis to complete. Given the unpredictable development of puberty, they felt a lot of stress and anxiety during this period and were primarily concerned about the lowering of their voice. Because of this puberty-related stress, they were constantly balancing their motivations for fertility preservation against the early start of puberty suppression to prevent unwanted irreversible pubertal body changes. To support this decisional dilemma, adolescents and their parents need adequate communication with each other and their healthcare providers to reflect on their stress for pubertal change. Furthermore, close, continuous surveillance of their current mental state by their parents, together with their psychologist and pubertal development by their physicians, is needed. Despite the challenging decision and postponement of puberty suppression, they retrospectively experienced it positively without any regret.
LIMITATIONS, REASONS FOR CAUTION: All adolescents successfully underwent TESE, with viable spermatozoa obtained and without complications. This may result in a more positive reflective experience regarding fertility preservation. Furthermore, the perspectives of adolescents with the intention of TESE but who already started with puberty suppression before the preservation were not included.
This study helps healthcare providers improve their counselling and guidance of transfeminine adolescents who consider postponing puberty suppression for fertility preservation via TESE. The adolescents and their parents know more clearly what to expect during fertility preservation. Specific peer-support programs may facilitate the decision process for upcoming adolescents.
STUDY FUNDING/COMPETING INTEREST(S): No external funding was used for this study. None of the authors have any conflicts of interest.
Not applicable.
transgender 青少年及其父母如何通过睾丸精子提取 (TESE) 来保存生育能力？
当为参与者提供适当的指导来解决在保留未来生物父母身份和早期开始青春期抑制之间的决策困境时，他们对 TESE 过程的体验是积极的。
由于生殖器畸形和早期青春期，并非所有 transgender 青少年都可以通过射精进行精子库存储；对于这组人来说，TESE 是唯一的选择。然而，在早期青春期，他们必须推迟或暂停青春期抑制，直到精子发生完全发育。
研究设计、大小和持续时间：我们邀请了我们中心的所有连续 TESE 患者及其父母参加。在 2022 年 12 月至 2023 年 5 月期间，我们纳入了 6 名青少年和 10 名父母。我们使用了基于半结构化访谈的定性方法，研究了 transgender 青少年及其父母的体验。
参与者/材料、设置、方法：接受过早期青春期（Tanner 阶段≥2）性别焦虑症诊断并在开始青春期抑制或性别肯定激素治疗之前接受 TESE 的 transgender 青少年参加了这项研究。访谈被记录下来，然后手动转录并使用反思性主题分析进行分析，重点是了解参与者对青春期和生育能力保存的体验以及影响他们决定进行 TESE 的各种因素和社会过程。
transgender 青少年决定进行侵入性生育能力保存，因为他们可能有未来的父母身份愿望。父母强调预防未来决策后悔的重要性。他们都认为获得精液样本的自慰是无法实现的。尽管 TESE 是一种可能有并发症的手术程序，并且之后会有疼痛，但对他们来说，这种选择似乎不那么令人反感。青少年不得不推迟青春期抑制的开始，等待精子发生完全发育。由于青春期的发展不可预测，他们在此期间感到很大的压力和焦虑，主要担心声音下降。由于这种与青春期相关的压力，他们一直在平衡他们对生育能力保存的动机与早期开始青春期抑制以防止不希望的不可逆的青春期身体变化。为了支持这一决策困境，青少年及其父母需要与彼此和他们的医疗保健提供者进行充分沟通，以反思他们对青春期变化的压力。此外，还需要他们的父母密切、持续地监测他们当前的精神状态，以及他们的心理学家和医生监测他们的青春期发育。尽管做出了具有挑战性的决定并推迟了青春期抑制，但他们回顾性地对其没有任何遗憾地表现出积极的态度。
局限性、谨慎的原因：所有青少年都成功地接受了 TESE 治疗，获得了可行的精子，没有并发症。这可能会导致对生育能力保存的反思体验更加积极。此外，本研究不包括那些打算进行 TESE 但在保存前已经开始进行青春期抑制的青少年的观点。
本研究有助于医疗保健提供者改善对考虑通过 TESE 推迟青春期抑制以进行生育能力保存的 transgender 青少年的咨询和指导。青少年及其父母更清楚地了解生育能力保存期间的预期情况。特定的同伴支持计划可能会促进即将到来的青少年的决策过程。
研究资金/利益冲突：本研究没有使用外部资金。作者均无任何利益冲突。
不适用。
