Semen Cryopreservation and Semen Quality in Transfeminine Adolescents Prior to Hormone Therapy

Some transgender individuals wish to become biological parents in the future and transfeminine persons may be offered cryopreservation of semen before starting hormone therapy. However, there is a lack of knowledge about semen cryopreservation outcomes among transfeminine adolescents seeking gender-affirming care.

To investigate transfeminine adolescents who decide for or against semen cryopreservation.

This is a retrospective observational national cohort study of 58 transfeminine individuals aged <18 years, assessing clinical data, semen parameters, and reproductive hormone levels.

Among the 58 individuals, 23 (39.7%) opted for semen cryopreservation and successfully collected a semen sample. They were older and more advanced in pubertal development compared with those who did not: median age was 16.4 years (range, 13.7-19.4) vs 15.8 years (11.7-17.9); Tanner stage G5 (4-5) vs G3 (2-4); and testis volume 20 mL (15-25) vs 8 mL (3-20). Among 17 individuals with no prior hormone therapy, the median sperm concentration was 11.1 × 10⁶/mL (0.02-163), semen volume 1.8 mL (0.2-3.9), total sperm count 17.8 × 10⁶ (0.1-214.2), and percentage of progressively motile spermatozoa 46% (8-74). Reproductive hormones were within normal ranges for age and registered sex at birth.

The percentage of adolescents opting for semen cryopreservation was comparable to other countries with a publicly financed national healthcare system. Overall, semen quality was impaired.