Transgender men as uterus donors for transplantation: A theoretical perspective

Approximately 25 million people worldwide do not identify with the sex assigned at birth. Treatment options for gender dysphoria are multidisciplinary and include gender-affirming hormone therapy and surgery. Uterus transplantation in women without a uterus is promising for treating absolute uterine factor infertility, and its efficacy has been demonstrated through successful transplant surgeries and subsequent births via cesarean section following single embryo transfer. Transgender men undergoing gender-affirming hysterectomy to alleviate gender dysphoria symptoms should be considered as potential uterus donors for transplantation. Although transgender men show positive attitudes toward uterus donation to women with infertility, who do not have a uterus, long-term gender-affirming testosterone therapy induces uterine changes that necessitate assessment before donation for transplantation should be considered. This commentary highlights the major challenges associated with uterus donation by transgender men for transplantation.