Iris de Nie

16 C H A P T E R 1 Another biologically male organ in trans women that is potentially at risk for cancer, is the prostate. The prostate is not removed during genital GAS because of the potential significant complications, such as incontinence. Therefore, trans women remain at risk for prostatic diseases after this procedure. As mentioned previously, it has been assumed that androgen deprivation therapy might have a preventive effect on the development of prostate cancer. However, androgen deprivation therapy in cis men is primarily used in patients diagnosed with advanced prostate cancer and only sporadically for other indications, such as to control sex impulses in patients with severe paraphilias. 46 Therefore, there are currently very limited data available about the influence of long-term androgen deprivation on the occurrence of prostate cancer. THESIS OUTLINE In this thesis we investigate two major topics. The first part focusses on fertility and family building, and in the second part we assess the risk for cancer of the male genital tract during gender-affirming hormone use. The first part of this thesis will start with an evaluation of the experiences of transgender people, who are currently of adult reproductive age (± 30 years), with starting gender- affirming treatment as adolescent before 2014 and, as a consequence, the inevitable decision to give up the possibility of genetic parenthood. In chapter 2 we will present their reflection on themes such as: how they experience their infertility in the present, how they experienced the topic fertility and the desire to have children during their transition, how they experienced the ‘choice’ of having to give up their fertility to be able to transition, if they -retrospectively- felt the need for reproductive counselling and fertility preservation and how they currently experience their gender identity in relation to their desire for children. Since the abolition of transgender laws that required sterilization for legal gender recognition, fertility preservation is now thoroughly discussed and offered to transgender people. In chapter 3 , we assess semen quality at time of fertility preservation before the initiation of GAHT in a large cohort of trans women, evaluate the adequacy for the different types of reproductive techniques and identify life style factors influencing semen quality. In addition, the aim of chapter 4 is to evaluate the influence of habitual behavior, more typically observed in trans women, on semen quality by obtaining data on the habit of bringing the testicles from the scrotal position into the inguinal canal (‘tucking’), wearing tight undergarments, and ejaculation frequency. In chapter 5 we will investigate the restoration of spermatogenesis in trans women who decide to temporarily discontinue GAHT for fertility preservation or for an attempt to naturally conceive with their female partner. We will present data on semen quality after gender-affirming hormone use and the duration to restore complete spermatogenesis.