Perspectivas sobre a preservação de fertilidade em pessoas transgênero

Abstract

Patient’s autonomy regarding reproduction and sexuality is a fundamental human right. However, for transgender people, gender-affirming hormone therapy (GAHT) can cause irreversible impacts on fertility. GAHT affects spermatogenesis and ovulation, with possible irreversible fertility loss, wich makes fertility preservation a relevant issue in transgender’s healthcare. This cross-sectional analytical observational study applied a questionnaire to 88 patients of a Reference Center for Comprehensive Transgender Healthcare at the University Hospital of the Federal University of Uberlândia, seeking to understand perspectives on parenthood, reproductive desire and fertility preservation; and identify possible factors that influence the responses. Among the participants, transgender men predominated (65.9%), under 29 years old (65.9%), heterosexual (45.4%), undergoing hormone therapy (78.4%), with five or more years of hormone therapy (45.6%), completed high school education (29.6%), and without children (87.5%). Regarding guidance on the effects of hormone therapy on fertility, 69.3% reported having been fully informed. Regarding fertility preservation before therapy, 52.3% stated they would not delay GAHT to use preservation methods and 63.6% would not have wanted to do so before starting treatment. At the current stage of hormone therapy, 68.2% denied interest in preservation methods. Regarding the desire to have children in the future, 61.4% expressed interest, although 41% answered that they did not intend to use their own gametes. Regarding parenthood with their current partner, 31.8% reported not having a partner, and 36.4% expressed interest in having children with their own or their partner's genetic makeup. A minority showed interest in gamete banking (28.4%), pregnancy (9.1%), or breastfeeding (11.4%). People without a partner were 17.44 times more likely (CI: 3.07–98.87, P = 0.001) and heterosexual people were 3.52 times more likely (CI: 1.04–11.88, P = 0.04) to want their own offspring. Education level and already having children at the current stage of treatment marginally influenced the responses. In the open-ended question about fertility during hormone therapy, different perceptions emerged: some believed that fertility could be restored if GAHT were interrupted; others considered themselves infertile due to prolonged use of the therapy; some accepted the reduction in fertility as a necessary consequence of undergoing GAHT; others understood that fertility could be impaired, but it would still be possible to conceive, with the risk of unplanned pregnancy. Transgender people face sociocultural, religious and legal barriers that hinder access to fertility preservation. Clear public policies, proper training for health professionals for assertive communication and adequate care, social transformations and greater representation of the transgender population in studies and discussions on the subject are fundamental to overcome this barriers.