## 3 Results  
In total, 154 TGNB-AMAB patients were referred to the FP program between 2016 and 2023. The number of patients referred per year significantly increased over time, starting with 5 patients in 2016 and increasing to 42 patients in 2023 (Figure 1, \(p\) = 0.001). Despite the increasing number of patients referred per year, the percentage of patients who completed the referral process (underwent consultation with a reproductive urologist or APP) and the percentage of patients who underwent sperm cryopreservation did not change over time. These ranged from 76.2 to 100.0% (\(p\) = 0.22 for trend over time) and 71.4-100.0% (\(p\) = 0.24 for trend over time), respectively (Table 1).  
The average age of the TGNB-AMAB patients referred to the FP program was \(20.5\pm 5.7\) years. Overall, 23.4% (n = 36) of patients were on GAHT prior to FP referral, with a significantly greater percentage of adult (\(\geq\)18 years of age) patients on prior GAHT than pediatric/adolescent patients (31.3% vs. 14.1%, \(p\) = 0.01). The median age of all patients with prior GAHT at the time of sperm banking was 20.7 years (interquartile range [IQR] 17.3-24.0 years).  
Among patients who underwent sperm cryopreservation, the median time from initial referral to sperm banking was two weeks (14 days, IQR 9-29 days). Patients banked sperm an average of 2.1 \(\pm\) 1.5 times and averaged 4.4 \(\pm\) 3.1 vials per bank. The average semen parameters among all the TGNB-AMAB patients were as follows: volume 2.7 \(\pm\) 1.7 mL, sperm concentration 36.0 \(\pm\) 31.6 M/mL, sperm motility 56.8 \(\pm\) 19.0%, and sperm morphology 4.7 \(\pm\) 2.9% (Table 2). Adult patients had a significantly greater ejaculate volume  
\begin{table}
\begin{tabular}{c c c c} \hline
**Year** & **Total Referrals (N)** & **Completed Referrals (n, \%) *** & **Samples Provided (n, \%) *** \\ \hline
2016 & 5 & 4 (80.0) & 4 (80.0) \\
2017 & 8 & 8 (100.0) & 8 (100.0) \\
2018 & 11 & 9 (81.8) & 8 (72.7) \\
2019 & 10 & 8 (80.0) & 8 (80.0) \\
2020 & 15 & 14 (93.3) & 12 (80.0) \\
2021 & 34 & 32 (94.1) & 31 (91.2) \\
2022 & 29 & 24 (82.8) & 23 (79.3) \\
2023 & 42 & 32 (76.2) & 30 (71.4) \\ \hline \multicolumn{3}{l}{\(p\)**-value**} & 0.001 & 0.22 & 0.24 \\ \hline \end{tabular}  
* Cochran-Armitage test for trend used to determine \(p\)-values.  
\end{table}
Table 1: Number and percentage of TGNB-AMAB patients who were referred to FP program, completed referral, and submitted a semen sample for cryopreservation by year.  
Figure 1: Number of patients referred to the GPP per year.  
(3.4 \(\pm\) 1.7 mL vs. 1.9 \(\pm\) 1.1 mL, \(p\) < 0.001), percent normal morphology (5.2 \(\pm\) 2.7% vs. 4.0 \(\pm\) 2.9%, \(p\) = 0.03), and TMSC (80.9 \(\pm\) 60.7 M vs. 36.4 \(\pm\) 41.1 M, \(p\) < 0.001) than pediatric/adolescent patients. However, there was no difference in serum testosterone or follicle-stimulating hormone (FSH) between age cohorts. There was also no difference in bulk semen parameters between TGNB-AMAB patients with and without prior utilization of GAHT (Table 3, \(p\) > 0.05).  
Lastly, among patients wishing to pursue GAHT, the median time to starting hormonal therapy after their last banking procedure was approximately two weeks (androgen receptor blocker = 17 days, IQR 6-52 days; estradiol = 13 days, IQR 3-43 days). The overall median time from the initial referral to the initiation of any form of GAHT was one month.