Iris de Nie

70 C H A P T E R 5 Viable spermatozoa were found in all nine individuals after cessation of GAHT (Table 1). Six had sperm present on their initial semen analyses taken 3-27 months after stopping hormones; two others had no sperm on their initial semen analyses, but eventually had sperm identified 8-10 months after hormone cessation; the remaining individual did not have any sperm identified in serial semen analyses up to 13 months after ceasing GAHT, but eventually had spermatozoa successfully extracted via testicular biopsy after 17 months. Table 1. Clinical characteristics of nine trans women who stopped GAHT and their subsequent semen analyses Patient 1 Patient 2 Patient 3 Patient 4 Initial presentation to gender clinic Location The Netherlands The Netherlands The Netherlands The Netherlands Age at first presentation to gender clinic 26 18 25 28 Age at diagnosis of Gender Dysphoria 28 21 25 28 Medical history left testicular torsion androgenetic alopecia n/a commenced hormone treatment on own initiative after purchasing online Psychiatric history n/a bipolar disorder n/a n/a Concurrent medication n/a finasteride (for alopecia) n/a n/a Baseline serum hormone levels Estradiol (pmol/L) 123 72 82 705 Testosterone (nmol/L) 27 19 15 < 0.5 LH (IU/L) 2.8 3.6 2.4 < 0.1 FSH (IU/L) n.d. n.d. n.d. Fertility history and previous counseling Previous children nil nil nil nil Reproductive desires prior to commencing oestrogen wish for fertility preservation, wants children in the future. used illicitly obtained hormones, no prior fertility counseling not discussed used illicitly obtained hormones, no prior fertility counseling Prior fertility preservation semen cryopreservation: 43 vials suitable for ICSI none none none Oestrogen therapy Age started 28 18 23 24 Agent estradiol patches estradiol valerate estradiol valerate estradiol valerate Starting dose 100mcg/24 hours twice a week 4 mg/day 2 mg/twice a day 2 mg/twice a a day