Reproductive Health in Trans and Gender Diverse Patients: Effects of transmasculine gender-affirming hormone therapy on future reproductive capacity: clinical data, animal models, and gaps in knowledge.

Murine models of T-GAHT have suggested reversibility of reproductive impacts in both post-pubertal and pre-pubertal populations.

• Relevant literature based on murine models in post- and pre-pubertal populations has suggested reversibility of the impacts of T-GAHT on reproduction.
• This reversibility was observed both for T-GAHT alone and following gonadotropin-releasing hormone agonist (GnRHa) co-treatment.
• Studies reported changes in clitoral area and ovarian morphology including corpora lutea, follicle counts, and ovarian weights from T-treated mice.

Current clinical standard guidance for T-GAHT patients regarding fertility lacks clarity and consistent information.

• Individuals are typically recommended to undergo fertility preservation or stop treatment, associating T-therapy with a loss of fertility.
• There is an absence of consistent information regarding the true fertility potential for transgender and gender-diverse adults and adolescents.
• Many transgender and gender-diverse individuals assigned female at birth seek parenthood, particularly as a gestational parent or through surrogacy.

T-GAHT produces measurable morphological changes in reproductive organs in animal models.

• Studies in T-treated mice reported changes in clitoral area.
• Ovarian morphological changes were observed including alterations in corpora lutea, follicle counts, and ovarian weights.
• These findings were drawn from both post- and pre-pubertal murine model populations.

Significant gaps in knowledge remain regarding the effects of T-GAHT duration and cessation on fertility outcomes.

• Future studies should aim to determine the impact of the duration of T-treatment and cessation on fertility outcomes.
• There is a need to establish animal models that are clinically representative of outcomes with respect to gender diverse populations.
• The review identifies the absence of consistent information regarding true fertility potential as a key gap in current knowledge.

Animal studies are needed to inform clinical guidance on the effects of testosterone gender-affirming hormone therapy on fertility.

• This review was conducted because animal studies are needed to inform clinical guidance on the effects of T-GAHT on fertility.
• The review summarizes current animal models of T-GAHT and identifies gaps in knowledge for future study.
• T-GAHT is frequently used by transgender and gender-diverse individuals assigned female at birth to establish masculinizing characteristics.