Semen Quality in Transgender Individuals Seeking Fertility Preservation
Maurizio De Rocco Ponce, Eden Troka, Massimiliano Raffo, Luis Miguel Malca Caballero, Alberto Ferlin, Andrea Salonia, Eduard Ruiz Castañé, Alberto Scala, Andrea Garolla,ABSTRACT
Background
Transgender individuals assigned male at birth (AMAB) may choose to preserve their fertility prior to starting gender‐affirming hormone therapy (GAHT). However, limited data exist regarding the baseline reproductive and hormonal characteristics of this population before and after GAHT.
Objectives
To characterize semen quality and hormonal profiles in transgender AMAB individuals prior to GAHT and compare findings with cisgender men and with transgender individuals who discontinued GAHT for at least 3 months.
Materials and Methods
This retrospective study included transgender AMAB individuals from two tertiary andrology centers who underwent sperm cryopreservation before GAHT initiation (treatment‐naïve group). Clinical evaluation included anthropometric measures, testicular volume assessment, varicocele detection, and sex hormone measures. Semen parameters were analyzed according to WHO criteria and compared with those of cisgender men and previously treated transgender individuals.
Results
Thirty‐two treatment‐naïve transgender AMAB individuals were included. Hormonal parameters were generally within reference ranges. Only 46.9% of treatment‐naïve individuals met WHO criteria for normozoospermia, compared with 75.5% of cisgender controls. Compared with nine previously treated individuals, estradiol levels were higher and seminal volume lower. A higher frequency of seminal abnormalities was observed, although not statistically significant.
Conclusions
A substantial proportion of treatment‐naïve transgender AMAB individuals exhibited impaired semen parameters prior to GAHT initiation. Prior GAHT exposure showed a trend toward poorer semen quality. These findings support early fertility counseling and preservation in transgender individuals prior to GAHT initiation.