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59 A COHORT STUDY ON FACTORS IMPAIRING SEMEN QUALITY IN TRANSGENDER WOMEN 4 Table 2. Effect of demographics, lifestyle factors, and medical history on semen parameters Semen volume < 1.5 ml OR (95% CI) Sperm concentration < 15x10 6 OR (95% CI) Total sperm number < 39x10 6 OR (95% CI) Progressive motility < 32% OR(95% CI) Total motile sperm count < 5 x10 6 OR(95% CI) Age at time of fertility preservation - years 0.95 (0.88-1.04) 0.97 (0.91-1.05) 0.99 (0.93-1.06) 1.05 (0.98-1.13) 1.01 (0.93-1.09) BMI – kg/m² 1.03 (0.95-1.11) 0.97 (0.89-1.05) 0.98 (0.91-1.05) 1.03 (0.95-1.11) 1.02 (0.94-1.10) Alcohol - yes/no 0.40 (0.17-0.97)* 0.48 (0.21-1.07)* 0.36 (0.16-0.81)* 0.76 (0.32-1.84) 0.24 (0.09-0.67)* Smoking - yes/no 1.57 (0.56-4.38) 1.41 (0.52-3.77) 2.35 (0.90-6.17) 0.50 (0.13-1.85) 0.56 (0.15-2.07) Cigarettes per day 1.00 (0.89-1.13) 1.03 (0.93-1.15) 1.04 (0.94-1.16) 0.88 (0.73-1.08) 0.89 (0.74-1.08) Cannabis use - yes/no 1.18 (0.41-3.41) 1.41 (0.52-3.77) 1.45 (0.55-3.82) 1.62 (0.55-4.77) 1.46 (0.25-8.44) Previous hormone use - yes/no 1.46 (0.25-8.44) 2.24 (0.43-11.70) 1.86 (0.36-9.70) 0.66 (0.07-5.88) 1.9 (0.33-11.11) History of anxiety or depression - yes/no 1.20 (0.50-2.89) 1.05 (0.46-2.39) 1.01 (0.45-2.28) 1.81 (0.74-4.41) 0.92 (0.35-2.39) History of urological problems - yes/no 0.94 (0.33-2.66) 0.49 (0.17-1.45) 0.88 (0.34-2.27) 1.15 (0.40-3.28) 0.68 (0.21-2.22) *p-value < 0.05 using logistic regression analyses. Ejaculation frequency, and the prevalence of wearing tight undergarment and tucking in our study cohort are presented in Table 3. Table 4 shows the effect of these factors on TMSC.The median ejaculation frequency in our cohort was 10 times a month (IQR 5.0-15.0). Logistic regression analysis showed a negative impact of a low ejaculation frequency on progressive motility, but it did not affect TMSC. Approximately half of the study population reported to never wear tight undergarment, the other half wears it sometimes (17.7%) or always (31.9%). Always wearing tight undergarment was associated with an impaired TMSC (OR 3.06, 95% CI 1.11-8.49), although this effect was no longer significant after adjustment for confounding factors. Tucking was performed by 26 of included transgender women (23.0%), a median 5.0 (IQR 1.0-30.0) times a month and with a median duration of 6.5 (IQR 5.0-8.0) hours per day. In total, 10 transgender women (8.9%) reported to perform tucking more than 8 times a month which was associated with a TMSC below 5 million (OR 6.09, 95% CI 1.54-24.01). This association did not change in the multivariable analysis (OR 7.95, 95% CI 1.66-37.99), and was mainly caused by a negative effect on sperm concentration. Table 5 demonstrates the effect of ejaculation frequency, wearing tight undergarment, and tucking on semen volume, sperm concentration, total sperm number, and progressive motility.