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64 C H A P T E R 4 Conclusions Transgender women can choose to cryopreserve their semen prior to starting GAHT, in order to retain the possibility to parent genetically related offspring later in life.However, semen quality in transgender women is often already impaired at time of fertilitypreservation and themajority of cryopreserved samples is only suitable for invasive ART to establish a pregnancy. With this cohort study, we are the first to report a negative impact of wearing tight undergarment and tucking on semen quality in transgender women. These results enable optimization of fertility counseling on how to adjust lifestyle before pursuing semen cryopreservation to improve future reproductive options.