Iris de Nie

20 C H A P T E R 2 ABSTRACT Objective: To investigate how adults of reproductive age (± 30 years), who started gender- affirming treatment during adolescence, reflect on their reproductive wishes. Materials and methods: Gender diverse adolescents who presented at our gender identity clinic since 1989 and commenced medical treatment at least 9 years ago were recruited for participation. Data were collected through an online survey, and a subsequent telephonic interview to validate the provided answers in the survey. Results: The cohort consisted of 89 participants (66 trans masculine and 23 trans feminine people) with a mean age of 32.4 years (range 25.5-51.2) at time of the study, and 15.6 years (range 11.5-20.6) at time of start of medical treatment. All participants initiated medical treatment before 2014, when laws requiring sterilization for legal gender recognition were still in place, and only 30% of participants reported to have received information about fertility preservation which none of them pursued. In addition, 96% of participants underwent gonadectomy and thus became permanently infertile, which was troublesome for 27%. With today’s knowledge, 44% of trans masculine and 35% of trans feminine people would pursue fertility preservation. The percentage of participants with a (future) desire for children increased from 34% at start of medical treatment to 56% at time of this study, of whom 23% had currently started a family. Conclusion: These results implicate that views and desires regarding fertility and family building may change over time. Therefore, we would recommend health care providers to counsel every transgender adolescent about the effect of medical treatment on fertility and the options for fertility preservation. Furthermore, it is of utmost importance to repeat fertility counseling in time and at each step of the transition process, and create a safe environment in which adolescents are able to change their mind regarding pursuing fertility preservation.