P-459 Timing of testosterone discontinuation and assisted reproductive technology in transgender patients
Authors: Albar M 
Published: June 2022

Abstract

Study question
What is the relationship between the duration of testosterone cessation and assisted reproductive technology outcomes in transgender patients?

Summary answer
There is no association between the timing of testosterone cessation &number of mature oocytes and the number of total oocytes in transgender patients undergoing ART

What is known already
Many transgender patients do not undergo fertility treatment, citing the delay or discontinuation of testosterone as the main reason. There has been an increase in the number of referrals to specialist clinics for hormone replacement for gender affirmation. There are variable reported durations in the literature on when to discontinue testosterone before starting the fertility preservation cycle. Presently, no guidelines specify the duration or necessity of testosterone discontinuation.

Study design, size, duration
This study is a retrospective cohort study of consecutive transgender patients seeking fertility preservation at single academic fertility clinic between October 2019 to June 2021. Patients that identify as transgender that started taking androgens for at least one month were included in the study. Transgender patients that did not start hormone replacement therapy were not included.

Participants/materials, setting, methods
Primary analyses evaluated whether an association between testosterone discontinuation duration & number of mature oocytes and total #of oocytes, adjusted for AMH & AFC. Secondary analyses included unadjusted analyses to evaluate whether an association between patient age, AMH, AFC, duration on HRT prior to ART, and duration off HRT prior to ART. The primary analysis was a multiple linear regression. Simple regression model was used for secondary analyses.

Main results and the role of chance
Nineteen patients (mean age 27.9 years [range 19-37], mean BMI 27.1 [20-34], mean AMH 24.8 [6.5-49], mean AFC 23.6 [11-50]) were included in the analysis. No patient underwent gender-affirming (eg: oophorectomy, hysterectomy) surgery. None of the patients were previously pregnant. Mean time on testosterone was 44.4 [1-96] months. Mean time off testosterone was 3.5 [0.6-13] months. All patients underwent egg freezing, except one who had embryo cryopreservation.
Simple linear regression showed that maternal age (p = 0.044), AMH (0.028), and AFC (p = 0.0008) were associated with the number of mature oocytes. Duration of time on testosterone (p = 0.319) and duration off testosterone prior to ART (p = 0.628) were not associated with the number of mature oocytes. For the outcome of total oocytes, age (p = 0.047), AMH (p = 0.042), and AFC (p &lt; 0.00001) were significant; duration of time on testosterone (p = 0.414) and duration off testosterone prior to ART (p = 0.471) were not significant.
Multiple regression models evaluating duration of time off testosterone prior to ART, adjusted for AFC and AMH, demonstrated no significant association with the outcome of mature oocytes (p = 0.712) and total oocytes (p = 0.564).

Limitations, reasons for caution
Thistudy is limited by including only 19 patients. The lack of effect of testosterone discontinuation duration and number of mature oocytes and total oocytes may be due to a lack of power. In addition, our study is single-centre, and may only include a small sample of transgender patients.

Wider implications of the findings
The majority of publications have documented successful ART outcomes in patients who have stopped testosterone for 3-6 months. Our study is critical as it is the first to evaluate whether an association exists between the timing of testosterone duration and ART outcomes.

Trial registration number
not applicable