Fertility preservation in transgender men without discontinuation of testosterone

OBJECTIVE: To report two cases of fertility preservation in two transgender men without an extended period of higher dose testosterone cessation. DESIGN: Chart abstraction was completed for two cases of oocyte preservation in transgender men without stopping testosterone gender-affirming therapy before controlled ovarian stimulation (COS). SETTING: A university-affiliated fertility clinic in San Francisco, California. PATIENT(S): Two 27-year-old transgender men on higher dose testosterone undergoing oocyte cryopreservation. INTERVENTION(S): Not applicable. MAIN OUTCOME MEASURE(S): Both patients had been on 6 and 20 months of testosterone therapy, respectively, and continued throughout COS. A random start antagonist plus letrozole protocol was used for the patient in case 1, with a leuprolide acetate trigger. A luteal start antagonist protocol was applied to the patient in case 2 with a leuprolide acetate trigger. RESULT(S): In case 1, a total of 35 oocytes were retrieved, with a total of 23 metaphase II (MII) oocytes cryopreserved. An additional 7 MII oocytes were obtained after in vitro maturation for a total of 30 MII oocytes that were vitrified. In case 2, 14 oocytes were retrieved, and 9 mature oocytes (MII) were vitrified. CONCLUSION(S): Transgender men have historically been advised to discontinue testosterone before COS, a process that may be distressing for many individuals. This is the first published case report demonstrating the proof of concept of COS without cessation of high-dose testosterone therapy in two transgender men. Future studies with larger sample sizes should be performed to confirm these findings.