Semen Parameters among Transgender and Gender Diverse Individuals Assigned Male at Birth Compared to Cisgender Men

Limited literature suggests that transgender and gender diverse (TGD) individuals assigned male at birth may have poorer semen parameters than cisgender persons. It is well known that gender-affirming hormone therapy (GAHT) can have a detrimental impact on sperm parameters; however, some studies suggest a higher proportion of sperm abnormalities, even among TGD individuals who had never initiated GAHT. Our objective was to compare semen parameters among TGD individuals to cis-gender men.

A retrospective cohort study included all patients who attempted to cryopreserve sperm at a fertility center from January 1, 2017 to June 30, 2022 for TGD indications (n=124). Baseline demographic information and pre- and post-freeze semen parameters before GAHT (n=111) were reviewed and compared to cis-gender controls (n=301) who provided semen samples for in vitro fertilization. Semen parameters among patients with prior exposure to GAHT (n=13) are also described.

TGD individuals had a higher likelihood of abnormal sperm concentration and/or motility compared to cisgender controls (odds ratio, 7.10; 95% confidence interval, 2.64 to 19.59; p<0.001). Despite no prior GAHT, almost half of the TGD patients had sperm concentration and/or motility below the 5th percentile. Significant between group difference in alcohol, cannabis and tobacco use was observed, with cisgender controls pursuing more of these behaviors (p<0.05). Despite this, mean sperm concentration (million/mL) and motility (%) were significantly lower in the TGD cohort, with higher volume (mL), with exclusion of patients with prior GAHT use.

TGD individuals had poorer semen characteristics at baseline compared to cis controls, prior to GAHT initiation. Semen parameter differences could not be attributed to behavioural patterns of substance use, highlighting the importance of identifying other causes of poorer semen parameters in the TGD population.