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

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

Iris de Nie  1 , Norah M van Mello  2 , Emanuel Vlahakis  3 , Charlie Cooper  4 , Angus Peri  4 , Martin den Heijer  1 , Andreas Meißner  5 , Judith Huirne  6 , Ken C Pang  7
Affiliations

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

Iris de Nie et al. Cell Rep Med. .

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.

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Conflict of interest statement

Declaration of interests The authors declare no competing interests.

Figures

None
Graphical abstract
Figure 1
Figure 1
Relationship between GAHT duration and the time when spermatozoa were first identified after stopping GAHT Note: patient 3 was excluded from this analysis given that their first semen analysis was significantly delayed (see Table 1).
See this image and copyright information in PMC

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References

    1. Tangpricha V., den Heijer M. Oestrogen and anti-androgen therapy for transgender women. Lancet Diabetes Endocrinol. 2017;5:291–300. doi: 10.1016/S2213-8587(16)30319-9. - DOI - PMC - PubMed
    1. Vereecke G., Defreyne J., Van Saen D., Collet S., Van Dorpe J., T'Sjoen G., Goossens E. Characterisation of testicular function and spermatogenesis in transgender women. Hum. Reprod. 2021;36:5–15. doi: 10.1093/humrep/deaa254. - DOI - PubMed
    1. Schneider F., Neuhaus N., Wistuba J., Zitzmann M., Heß J., Mahler D., van Ahlen H., Schlatt S., Kliesch S. Testicular functions and clinical characterization of patients with gender Dysphoria (GD) undergoing sex reassignment surgery (SRS) J. Sex. Med. 2015;12:2190–2200. doi: 10.1111/jsm.13022. - DOI - PubMed
    1. Schulze C. Response of the human testis to long-term estrogen treatment: morphology of Sertoli cells, Leydig cells and spermatogonial stem cells. Cell Tissue Res. 1988;251:31–43. doi: 10.1007/BF00215444. - DOI - PubMed
    1. Matoso A., Khandakar B., Yuan S., Wu T., Wang L.J., Lombardo K.A., Mangray S., Mannan A.A.S.R., Yakirevich E. Spectrum of findings in orchiectomy specimens of persons undergoing gender confirmation surgery. Hum. Pathol. 2018;76:91–99. doi: 10.1016/j.humpath.2018.03.007. - DOI - PubMed

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