Successful restoration of spermatogenesis following gender-affirming hormone therapy in transgender women

Iris de Nie; Norah M van Mello; Emanuel Vlahakis; Charlie Cooper; Angus Peri; Martin den Heijer; Andreas Meißner; Judith Huirne; Ken C Pang

doi:10.1016/j.xcrm.2022.100858

Successful restoration of spermatogenesis following gender-affirming hormone therapy in transgender women

Cell Rep Med. 2023 Jan 17;4(1):100858. doi: 10.1016/j.xcrm.2022.100858.

Authors

Iris de Nie¹, Norah M van Mello², Emanuel Vlahakis³, Charlie Cooper⁴, Angus Peri⁴, Martin den Heijer¹, Andreas Meißner⁵, Judith Huirne⁶, Ken C Pang⁷

Affiliations

¹ Department of Endocrinology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands; Center of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands.
² Center of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands; Department of Obstetrics and Gynecology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands.
³ Coffs Harbour Sexual Health Clinic, Coffs Harbour, NSW, Australia.
⁴ Clinical Sciences, Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Adolescent Medicine, Royal Children's Hospital, Melbourne, VIC, Australia.
⁵ Department of Endocrinology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands; Center of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands; Department of Urology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.
⁶ Department of Obstetrics and Gynecology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands.
⁷ Clinical Sciences, Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Adolescent Medicine, Royal Children's Hospital, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia. Electronic address: ken.pang@mcri.edu.au.

Abstract

Increasing numbers of transgender individuals are presenting for gender-affirming medical care. For trans women, gender-affirming hormone therapy (GAHT) promotes feminization but also inhibits spermatogenesis. There is a common untested assumption that this inhibition is permanent, resulting in infertility. In this longitudinal study, we report the recovery of viable spermatozoa in nine trans women who stopped GAHT for reproductive purposes. Our preliminary findings suggest that the negative impact of GAHT on spermatogenesis can be reversed, casting doubt on previous claims that GAHT in trans women inevitably leads to permanent infertility. Larger studies are needed to confirm our findings, which have implications not only for fertility counseling and the reproductive options of transgender individuals but also efforts to restrict access to GAHT based on fertility grounds.

Keywords: anti-androgens; azoospermia; estrogen; fertility; gender-affirming hormones; spermatogenesis; transgender.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Female
Hormones
Humans
Infertility*
Longitudinal Studies
Male
Spermatogenesis
Transgender Persons*

Substances

Hormones