Published in Pediatrics, researchers found that after a few months of discontinuing puberty-halting medication, sperm production was still possible in a transgender patient.
Scientists at Magee-Womens Research Institute (MWRI), collaborating with clinicians at UPMC Magee-Womens Hospital and UPMC Children’s Hospital of Pittsburgh report two cases in which young transgender women attempted to recover their fertility after starting and stopping gender-affirming medications. The study found that one transgender woman was able to produce viable sperm after a few months of discontinuing her puberty-halting medication, whereas a different patient on hormone therapy discovered sperm production was not possible during the time she could psychologically tolerate being off her medication.
Examining sperm production
Lead author Hanna Valli-Pulaski, a research assistant professor at MWRI explains: “We were interested in examining the timeline for getting viable sperm after stopping masculinity-suppressing medication”.
“Going on and off gender-affirming medications can cause psychological distress in this population and it’s important patients have a discussion with their health care provider before starting or stopping any treatment.”
The research team examined medical records of two transgender women who tried to preserve their sperm after stopping hormone therapy and compared the quality of semen against eight other transgender women who elected to preserve their sperm before beginning therapy.
All of the study participants came through the Fertility Preservation Program in Pittsburgh between 2015 and 2018 as young adults.
Details of the study
One of the patients who elected to preserve their sperm after beginning therapy had been taking the drug Lupron, a sex hormone blocker that halts puberty when taken in adolescence, for six months. She elected to stop taking Lupron to attempt sperm cryopreservation.
Five months later, she was able to produce a sperm sample comparable to those collected from the eight transgender women who saved their sperm prior to undergoing treatment.
Although this one case shows that it is possible to recover sperm after starting gender-affirming therapy, stopping medication for even just a few months can affect mental health, Valli-Pulaski said.
For male-to-female transgender individuals, facial hair can start to grow and the voice begin to deepen after just a few months of stopping medication. It’s possible to reverse these effects, but it would take time.
Fertility doesn’t always return so quickly
What’s more, a second case included in this study showed that fertility doesn’t always return quickly after going off gender-affirming drugs.
This patient had been taking estradiol and spironolactone for more than two years. Four months after stopping treatment, she was still unable to produce viable sperm, and at that point, she decided to stop trying for fertility preservation and proceeded with gender reassignment surgery.
Valli-Pilaski explained that the sperm production results of the two study participants provide valuable information that clinicians can share with future patients wishing to have biological children after beginning gender-affirming therapy.
“Right now, there’s not much information available about fertility preservation for transgender patients,” Valli-Pulaski said. “If you have any data, it’s important to share so that patients, researchers and clinicians can learn from it.”