(277) Predictors of Cryopreserved Sperm Quality Among Transgender Females Compared to Cisgender Males
Authors: Nguyen V , Sabet M , Anger J , Hsieh T 
Published: February 2024

Abstract

Introduction
Approximately 70% of transgender females express future interest in having children (Auer et al, 2018). However, studies have demonstrated poor semen parameters among this population who undergo sperm cryopreservation (Rodriguez-Wallberg et al, 2021). It remains poorly understood the underlying etiologies which place individuals at increased risk of suboptimal semen parameters.

Objective
We sought to identify clinical predictors of lower sperm quality among a cohort of transgender females and to compare this to a cohort of cisgender males.

Methods
We retrospectively identified 19 transgender women who underwent sperm cryopreservation at a single andrology lab within an academic institution between November 2021 and April 2023. We identified 16 age-matched cisgender male patients who also underwent sperm cryopreservation prior to oncologic treatment or vasectomy during this period. Data was abstracted from the electronic medical record. Statistical analysis was performed using SPSS version 28.

Results
Median age and body mass index of the transgender cohort was 25 years (range: 18-35) and 25.1 kg/m2 (range: 18.0-51.5). Median age and BMI of the cisgender cohort was 29 years (range: 17-37) and 25.2 kg/m2 (range: 18.7-38.0). Cisgender patients underwent sperm cryopreservation for oncologic treatment (81%) and pre-vasectomy planning (19%). 32% of transgender patients were initiated on gender affirming hormonal therapy (estradiol, spironolactone, or both) prior to semen analysis, with mean duration of 25 months (range: 1-108). 37% of transgender and 13% of cisgender patients were on a psychiatric medication with mean duration of 7.6 months (range: 1-19) and 7.5 months (range: 3-12) preceding sperm cryopreservation. 11% of transgender and 6% of cisgender patients endorsed tobacco use. 37% of transgender and 38% of cisgender patients endorsed alcohol use. Mean total motile sperm count (TMSC) was 61 million in the cisgender cohort and 105 million in the transgender cohort (p=0.159). 21% and 38% of the transgender and cisgender cohort had low TMSC (&lt;10 million). Mean post-thaw motility recovery was similar among the two groups (56% vs 57%, p=0.894). Transgender women on hormonal therapy had lower TMSC (p=0.867) and post-thaw motility recovery (p=0.535; Table 1) compared to their hormone-naïve counterparts. Alcohol use was a significant predictor of decreased post-thaw motility recovery among cisgender patients (63% vs 46%; p=0.011; Table 2).

Conclusions
Cisgender men had lower TMSC, but this was likely confounded by underlying malignancy. There was a trend toward worse semen parameters among transgender women with a history of hormone use, but larger studies are needed to validate this finding. Psychiatric medications similarly did not appear to be significant predictors of sperm quality among transgender women. Further studies are needed with a larger sample size and cisgender males without malignancy to validate the effect of these modifiable lifestyle factors.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific, Endo Pharmaceuticals.