Iris de Nie

25 REFLECTING ON THE IMPORTANCE OF FAMILY BUILDING AND FERTILITY PRESERVATION 2 Total (n=89) Trans feminine (n=23) Trans masculine (n=66) Sexual orientation* Heterosexual Homosexual/lesbian Bisexual Asexual Not indicated Other 70% (16) 4% (1) 18% (4) 0% (0) 4% (1) 4% (1) 62% (41) 9% (6) 22% (15) 2% (1) 3% (2) 2% (1) Children (biological/step-/foster/adoption) 23% (20) 0% (0) 30% (20) ~Poverty line is 971 euros/month (single); 1330 euros/month (cohabiting); 1620, 1830, 2000 euros/month (couple with 1, 2, 3 children); 1300, 1470, 1710 euros/month (single-parent family with 1, 2, 3 children). *heterosexual: attracted to opposite gender, homosexual/lesbian: attracted to same gender, bisexual: attracted to opposite and same gender, asexual: not attracted to others. Information about effect of treatment on fertility and options for fertility preservation 61% of participants reported to have received information about the effect of medical treatment for gender dysphoria on their fertility, 16% did not receive this information and 23% did not remember. However, only 30% of participants received information about the options for fertility preservation, whereas 44% of those who did not, would have liked to receive this information. Although 34% had a strong desire to have children at time of starting medical treatment (Figure 1), none of the participants pursued fertility preservation. The most reported reasons for not freezing eggs or sperm were it not being an option (27%) or not knowing about this option (25%), not feeling the need to do so (20%), not wanting to discontinue treatment (16%), or finding the procedure too burdensome (17%) or too expensive (6%). Nine participants (10%) mentioned not wanting a child from gametes that are not in line with their gender identity, a trans woman explained it as follows: “I would not biologically want to be the father of my children. I think I would always have to think about that when I would look at my children. And I wouldn’t want my children finding out and what a disappointment that must be for them.” Capacity of making decisions and reflecting on infertility through treatment When asked whether participants felt that they were old enough to make decisions about fertility at the start of medical treatment, 51% responded positive and 11% did not know. Nonetheless, 21% of participants felt that they were not old enough and indicated that they could only oversee these decisions when reaching a median age of 18 year (IQR 18-22). Of the study cohort, 96% underwent gonadectomy and thus became permanently infertile. At that moment this was troublesome for 11% of participants, while at time of this study this was troublesome for 27% of participants. The most reported reasons for finding it