Some Transgender Women May Be Able to Make Sperm

Researchers are exploring fertility preservation in transgender women. And while they say there are no guarantees, they report it's possible to start producing sperm after stopping drugs that suppress maleness.

In a new case report, researchers found one of two patients produced sperm after discontinuing her puberty-halting medication. However, the other patient wasn't able to produce sperm in the time she was able to psychologically tolerate not taking her medication, the investigators found.

"We were interested in examining the timeline for getting viable sperm after stopping masculinity-suppressing medication," said lead author Hanna Valli-Pulaski. She is a research assistant professor at the University of Pittsburgh Medical Center's Magee-Womens Research Institute.

"Going on and off gender-affirming medications can cause psychological distress in this population and it's important patients have a discussion with their health care provider before starting or stopping any treatment," she added in a university news release.

Using medical records, the researchers looked at two transgender women who tried to preserve their sperm after starting and stopping gender-affirming hormone treatment. The investigators compared the results with those of eight transgender women who preserved their sperm before starting therapy.

One of the patients ceased taking Lupron, a sex hormone blocker that stops puberty. Five months after stopping the drug, she was able to produce sperm that were similar to the sperm of the transgender women who preserved sperm before therapy.

But stopping Lupron can cause psychological stress for those transitioning from male to female, as facial hair can start to grow and the voice may deepen after only a few months.

It takes time to reverse these conditions, the researchers noted.

Moreover, stopping hormone medication may not guarantee sperm production. The second patient, for example, had been taking estradiol and spironolactone for more than two years.

After not using the drugs for four months, she still couldn't produce sperm. At that point, she stopped trying and proceeded with gender reassignment surgery.

"Right now, there's not much information available about fertility preservation for transgender patients," Valli-Pulaski said. The study provides valuable information for researchers, clinicians and patients, she said.

The report was published online Aug. 5 in Pediatrics.

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