Reproductive capacity after gender-affirming testosterone therapy.

Area of Science:

• Reproductive endocrinology and transgender health.
• Investigating the effects of hormone therapy on reproductive capacity.

Background:

• Transgender and nonbinary individuals assigned female at birth often use testosterone therapy for masculinization.
• Fertility preservation is recommended before starting testosterone, but access barriers exist.
• Some individuals may desire future reproduction after testosterone use, raising questions about reproductive outcomes.

Purpose of the Study:

• To explore the reproductive impact of long-term masculinizing testosterone therapy in transgender and nonbinary individuals.
• To highlight the need for understanding the reversibility and functional consequences of testosterone on the reproductive system.

Main Methods:

• Review of emerging literature on pregnancies and assisted reproduction in individuals after testosterone therapy.
• Analysis of current knowledge gaps regarding the effects of testosterone on ovarian, uterine, and fallopian tube function.

Main Results:

• Limited but emerging evidence suggests successful pregnancies and assisted reproduction are possible after testosterone use.
• The precise impact of testosterone on reproductive organs (ovaries, uterus, fallopian tubes) and the reversibility of these changes remain unclear.
• Predicting successful reproductive outcomes for individuals after testosterone therapy is not yet established.

Conclusions:

• Significant questions persist regarding the long-term reproductive consequences of masculinizing testosterone therapy.
• Further research is a priority to understand testosterone's effects on reproductive capacity and to inform fertility preservation counseling.