SUN-130 Variation in Gender-Affirming Care Initiation and Fertility Preservation Strategies Among Transgender Youth

Abstract Disclosure: D. Shill: None. M. Farimata: None. R. Kasdin: None. C.J. Romero: None. R. Fader: None. N. Malhotra: None. M. Yau: None. Background: The goals of gender affirming hormone therapy (GAHT) are to better align one’s appearance and physical characteristics with their gender identity and reduce dysphoria due to the secondary sex characteristics of the gender assigned at birth. However, options and timing for GAHT, dosing increases, and fertility preservation after consultation vary based on individual preferences. Trends in utilization of management options among transgender and gender diverse (TGD) youth, which are not well understood, can inform service delivery. Objective: To examine care utilization rates of TGD and non-binary youth once connected to pediatric endocrinology and to identify improvement areas in treatment initiation and fertility preservation. Design/Methods A retrospective cohort analysis was conducted at an outpatient urban pediatric endocrinology clinic. Inclusion criteria were patients with TGD or non-binary identity, age < 23 years, and initiating care between 2020-2023. Charts were reviewed for patient demographics, medication history, and referrals to ancillary clinics. Primary outcomes included rates of hormone therapy initiation, puberty blockade, and successful fertility preservation. Results: 89 patients met inclusion criteria; 37 were transgender girls, 40 were transgender boys, and 12 were non-binary. On average, transgender girls presented for care at 14.47 years of age, while transgender boys presented at 15.57 years of age. 40 patients (44.9%) initiated puberty blockers and 52 patients (58.4%) initiated GAHT. Of the 52, 17 (19.1%) started estrogen and 35 (39.3%) started testosterone. 4 patients were taking hormonal birth control. 5 patients were awaiting follow-up before starting medication, and 2 were not on medication and had no plans of imminently starting. Additionally, 20 (23.8%) of the 89 patients successfully completed fertility preservation prior to starting GAHT. More specifically, 53.1% of transgender girls and no transgender boys underwent fertility preservation. Conclusions: Management options for GAHT and fertility preservation vary depending on age at presentation and assigned sex at birth. More transgender girls started on puberty blockers than transgender boys, possibly due to younger age and earlier Tanner Stage on presentation. In the cohort, only assigned-male-at-birth (AMAB) youth underwent fertility preservation prior to GAHT. This is likely due to the ongoing suppression of sperm production once puberty blockers or GAHT are initiated, making it vital to ensure early fertility preservation in this population. There are also increased financial barriers to fertility preservation for youth interested in egg freezing compared to sperm freezing. Expanding education and accessibility around GAHT and fertility preservation options can ensure that TGD youth are prepared to make decisions that align best with their goals of care. Presentation: Sunday, July 13, 2025