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  • Friday, June 17, 2016
  • 0706-000235 FERTILITY ISSUES FOR YOUTH: PUBERTY BLOCKERS, HORMONES AND DECISION-MAKING THROUGH THE LENS OF FAMILY BUILDING OPTIONS

    June 20, 2016 4:45 PM - June 20, 2016 5:45 PM

    Mirror Studio

    • Diane Ehrensaft, PhD ;
    • Jennifer Hastings, MD ;
    • Kathy Hsiao, MD
    In our practices, more trans individuals are coming to us with the desire to have their own biological children. For those who have not had gonadectomy, this is a reality: transgender women are contributing their sperm and transgender men are getting pregnant and giving birth. This symposium will explore current and future options for transgender youth making choices about puberty blockers and hormone replacement therapy. We focus on the process of making decisions about the timing of medical interventions from the perspective of future fertility, considering the viewpoints of both youth and parents or guardians who will be giving legal consent for interventions. A schema will be presented for understanding current and future fertility options for persons with ovaries and testes, with or without puberty blockers and hormones.    The psychological implications of using puberty blockers and hormones for gender affirmation among pubertal and post-pubertal youth are extensive and complex. The most recent indicator of this complexity: fertility and future fertility options, an issue not consistently discussed by providers with patients during the consent process. With parents’ legal consent, youth can embark on a progression from puberty blockers at Tanner Stage Two of puberty to hormones to bring their bodies into alignment with their affirmed gender identity. Presently, this sequential treatment comes with a considerable price tag: the loss of the ability to produce viable gametes and conceive a genetically related child.   Calling on Erikson’s eight stages of development, theoretically the questions, explorations and self-knowledge about childbearing do not surface until early adulthood. Thus, we are asking parents and children to collaboratively, but prematurely, make significant decisions regarding their child’s future life as a potential parent. To date, no assured ways exist for youth considering the options of blockers and hormones to preserve their gamete material to conceive a child. Alternative pathways for family building exist—adopting or fostering a child—and the symposium will report on clinical observations of youth’s perspectives on future family building options as weighed against present gender affirmation choices.   We will also present research from the field of juvenile oncology for developing gametes in vitro, which while not available for transgender youth at present, may dramatically change the decision process regarding blockers.   We will consider developmental, psychological and physiological challenges for the child, challenges for the parent(s)/caregivers, and the obligations of the interdisciplinary professional teams working with the child, specifically medical and mental health professionals. Synthesizing research to date from the fields of reproductive technology and pediatric gender health, along with clinical examples from work within an interdisciplinary university hospital pediatric gender clinic and a community health setting, a template will be presented of pathways that providers, youth and parents have co-created to address fertility and hormone replacement therapy, along with both the risk and ethical issues involved on both sides of the equation: withholding blocker to preserve future fertility versus administering blocker followed by hormone treatment to preserve optimal gender affirmation, forfeiting fertility.


    Category: Pediatrics and Adolescent Health