Attitudes, Counselling and Decisional Regret Towards Fertility Preservation in Transgender and Gender-Nonconforming...

Gender-affirming hormone therapy may affect reproductive capacity, but the extent and reversibility remain uncertain. Guidelines recommend that transgender and gender-nonconforming individuals receive counseling on fertility preservation options before initiating hormones and periodically thereafter: however, the evidence on quality and implementation of counseling, as well as decisional regret, is scarce.

We present a cross-sectional study using an anonymous online survey disseminated across Italy (March - August 2025). The survey included: (1) an ad hoc questionnaire on demographics, attitudes toward fertility preservation, counseling and the whole processes; and (2) the Decision Regret Scale (DRS). Eligible participants were transgender adults residing in Italy.

The survey reached 679 individuals; 548 (80.7%) responses were suitable for analysis. Fertility preservation uptake was low: 21 respondents (4.6%) underwent fertility preservation prior to or during their gender-affirming pathway, and only one ultimately used his gametes. Counseling on fertility preservation was not systematically offered and was frequently perceived as suboptimal. Among those completing the DRS, 251 (67.3%) reported decisional regret, which was associated with the current importance placed on building a family (p < 10^-4), and with poorer satisfaction with working conditions at the time of the FP decision (p = 0.018).

In Italy, fertility preservation is seldom pursued among transgender individuals and counseling appears inconsistently implemented and often of suboptimal quality. Decisional regret regarding fertility preservation was common and appeared linked to evolving life priorities and contextual factors. Systematic, high-quality fertility preservation counseling and longitudinal support are needed to enable informed reproductive choices and reduce later decisional regret among transgender individuals.