For those assigned female at birth who desire masculinising hormones, it was historically assumed that testosterone was likely to damage ova (eggs), and that recovering ova for fertility treatment would require stopping testosterone. Several authorities and guidelines have recommended fertility preservation prior to commencing testosterone if biological parenting is desired. This systematic review gathers the available published evidence and makes some encouraging conclusions.

Among those who ceased testosterone to undergo fertility preservation, egg retrieval was surprisingly successful.Duration of testosterone treatment did not affect success rates. In one study, the number of ova retrieved from trans men was the same as the number retrieved from cis women undergoing fertility preservation.

However, the authors noted that rates of dysphoria associated with ceasing testosterone were high.

In a new approach, several studies described successful retrieval of ova from trans men who underwent fertility treatments while continuing their testosterone. Several studies demonstrated successful recovery of ova from trans men undergoing hysterectomy.

While these results are encouraging, they are just the start of gathering high quality research about these effects. More studies are needed to tease out the details of how testosterone treatment impacts the quantity and quality of ova among trans men treated with testosterone.

The authors conclude that more research is needed to provide trans people and their clinicians the best information to guide decisions about fertility preservation. Clearly the previous beliefs about testosterone and its effects on ova need to be revised. Meantime, freezing some eggs before starting remains an option whilst more research helps us understand long term fertility outcomes.

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Check out the full research article: Barrero JA, MockusI. Preservation of fertility in transgender men on long-term testosteronetherapy: a systematic review of oocyte retrieval outcomes during and afterexogenous androgen exposure. Transgender health. 2023 Oct1;8(5):408-19

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Geek Out by Dr Stuart Aitken

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