Transgendered men typically need to go through a series of hormone treatments as part of the process. For some of these individuals preserving their original ovarian reserve is also very important, should they choose to pursue a family later in life. Fortunately, new research has returned some positive results suggesting that it might be possible to preserve an ovarian reserve during the cross-sex treatment process.
A key study on the topic, headed by doctors from Tel Aviv-Sourasky Medical Center in Israel, looked at 52 transgender men who were undergoing a special type of testosterone therapy, that included monitoring the levels of the anti-mullerian hormone. Also known as AMH, it indicated that the levels were slightly reduced, yet they still remained within what would be considered the “Normal Range.”
They noted that on average, a patient’s AMH levels started around 5.65 ng/mL before initiating testosterone therapy. At that point, AMH levels gradually decreased to 4.89 ng/mL a full 12 months after initiation. This information was originally revealed for publication at the 2019 annual meeting of The Endocrine Society held in New Orleans, Louisiana.
The doctors and specialists who were monitoring the process note that there was very little appreciable change in the antral follicle count. While there was a slight decrease, it was not significant, even after a full year of testosterone hormone therapy. This can shed new light on a variety of factors in the field.
It’s also worth noting that along with antral follicle count, other factors like endometrial thickness and things like the production of the follicle-stimulating hormone had also decreased. Yet the deviation from the baseline was not significant. However, there were some significant changes in monitored levels of other factors and hormones. Most notably :
- Estradiol was 90.8 vs 55.4 pmol/l
- Testosterone was 0.84 vs 7 nmol/l
- Luteinizing hormone was 7.56 vs 3.8 mIU/ml
While these levels were generally high before and after testosterone therapy they were still above the normal range of 1.5-4.0 ng/ml. In some cases, they were considered to be in the “High” range. It’s also worth considering that some of these variances might also be an indicator of polycystic ovary syndrome.
In most of these cases, the transgender man chooses to receive testosterone as part of a gender-affirming treatment process. Some of these individuals indicated that they may later want their own children through their own pregnancy, or via a pregnancy carried by a surrogate.
There are several specialists in the field who also note that this could be yet another important step in recognizing and better defining the rights of transgender people. This specifically includes recognizing their reproductive rights.
Another important aspect of the study focused on open-label blood samples as well as pelvic ultrasound examinations that were administered at baseline and again 12 months after the start of the treatment process. This included administering testosterone enanthate 250 mg of IM at three-week intervals. Then hormone levels were again measured 10 days after each of the injections. The participants also filled out comprehensive questionnaires on socio-demographics, as well as information related to family planning, and topics related to sexual orientation.
A little over 30% of the respondents had already undergone a mastectomy before the start of hormone therapy. At the same time, 41% also said they’d experienced irregular menses, which could possibly indicate a higher chance of Polycystic Ovarian Syndrome in the sampled population. It’s also worth noting that 50% said they intended to undergo oophorectomy to remove one or both of their ovaries at some point in the process..
Another factor to consider is that 66% of the participants indicated that they eventually wanted to have children of their own, yet only 7% engaged in effective fertility preservation measures before they started transgender hormone therapy. In this subset, there were five individuals who indicated that they were only sexually attracted to females. Yet a year after undergoing testosterone therapy they indicated that they identified as bisexual.
One attendee at The Endocrine Society also offered that transgender men tend to prefer testosterone levels that are at or above what are considered normal levels. This might also increase the challenges associated with the process of ovarian preservation.
There were several specialists in the field who also noted that while a high percentage of individuals prefer very high levels of testosterone therapy in the earliest stages, that the physicians providing treatment still advocate safe levels. This is largely guided by data related to attaining the natural testosterone levels that you would find in a physiological healthy male in the same age range. These limits and ranges are also designed to protect the individuals from undue complications like erythrocytosis and problems with increased aggressiveness.
Several physicians including those at the Icahn School of Medicine at New York City’s Mount Sinai recognize that fertility risk is one of the more significant challenges associated with providing care for transgender individuals. It can also help to further identify their reproductive rights, regardless of the phase of treatment.
Many of these specialists also note that there is evidence that harvesting viable eggs from individuals who are engaged in testosterone therapy may be very important hopeful news for transgender men who want to have a family of their own. Yet there is no hard and conclusive data that shows these harvested eggs will result in a successful pregnancy that can be brought to full term.
Certainly, there is more research needed in this area. Yet the early returns suggest that there is hope, even for those who have started testosterone therapy, and reconsidered their interest in having a family.
There may indeed be new studies in the works that can springboard off of the data put forth by the Tel Aviv-Sourasky Medical Center study. Going forward there may be more options for transgender men who may have discounted the idea of having a family of their own.
Source – Medpage Today