Desire for genetically related children among transgender and gender-diverse patients seeking gender-affirming hormones

OBJECTIVE: To assess predictors of desire for genetically related children among a national cohort of reproductive-age transgender and gender-diverse patients aged 18 to 44 years initiating gender-affirming hormone therapy for the first time. DESIGN: Cross-sectional study. SETTING: National telehealth clinic. PATIENTS: A cohort of patients from 33 US states initiating gender-affirming hormone therapy. A total of 10,270 unique transgender and gender-diverse patients—aged 18 to 44 years (median age 24 years), with no prior use of gender-affirming hormone therapy—completed clinical intake forms between September 1, 2020, and January 1, 2022. INTERVENTION(S): Patient sex assigned at birth, insurance status, age, and geographic location. MAIN OUTCOME MEASURE(S): Self-reported desire for children using own genetic material. RESULT(S): Transgender and gender-diverse patients seeking gender-affirming medical treatments who are open to having genetically related children are an important population to identify and appropriately counsel. Over one quarter of the study population reported being interested in or unsure about having genetically related children, with 17.8% reporting yes and 8.4% unsure. Male-sex-assigned-at-birth patients had 1.37 (95% confidence interval: 1.25, 1.41) times higher odds of being open to having genetically related children compared with female-sex-assigned-at-birth patients. Those with private insurance had 1.13 (95% confidence interval: 1.02, 1.37) times higher odds of being open to having genetically related children compared with those without insurance. CONCLUSION(S): These findings represent the largest source of self-reported data on the desire for genetically related children among reproductive-age adult transgender and gender-diverse patients seeking gender-affirming hormones. Guidelines recommend that providers offer fertility-related counseling. These results indicate that transgender and gender-diverse patients, particularly male-sex-assigned-at-birth individuals and patients with private insurance, could benefit from counseling regarding the impacts of gender-affirming hormone therapy and gender-affirming surgeries on fertility.