SUN-134 Paused, Not Permanently Gone: A Case Report on Viable Spermatozoa After Cessation of Gender-Affirming Feminizing Hormone Therapy

Abstract Disclosure: P. Pile: None. B. Shute: None. P. Luthra: None. Introduction: Transwomen may seek gender-affirming feminizing hormone therapy (GAHT) to achieve feminization. GAHT can rapidly impair spermatogenesis and cause infertility. We present a case of a transwoman who was able to successfully cryopreserve viable spermatozoa after cessation of GAHT for 3 months. Case Presentation A 34-year-old transwoman was on GAHT for 2 years with oral estradiol 4 mg daily, spironolactone 50 mg daily and finasteride 5 mg daily. Patient was unable to cryopreserve spermatozoa for fertility before the initiation of GAHT. Laboratory tests on GAHT, showed: total testosterone 441 ng/dL (250-1100 ng/dL), free testosterone 31.2 pg/mL (46.0-224.0 pg/mL), bioavailable testosterone 64.1 ng/dL (110.0-575.0 ng/dL). Estradiol level was not available. To improve chances of cryopreservation, GAHT was discontinued for 3 months. Subsequent semen analysis showed: concentration 56 millions/mL (>15 millions/mL), 53% progressive motility (>32%), 4.8 mL volume (>1.50 mL), 30 millions/mL concentration motile sperm, 7% normal morphology (>4%). The sample was then successfully sent for cryopreservation. Discussion: The quality and quantity of spermatogonia are significantly reduced in transwomen receiving GAHT. Estrogens and antiandrogens suppress testicular function which may induce arrest of spermatogenesis. This case illustrates the potential transient impact of GAHT on spermatogenesis. The presence of viable sperm was evident as early as 3 months after withdrawal of GAHT. Given the short duration of the withdrawal period, it is possible that there is minimal reversal of feminizing changes. In our patient, the testosterone level was intentionally never fully suppressed on GAHT in an attempt to preserve fertility, which may likely have prevented her from developing azoospermia. Conclusion: This case provides important implications in transgender individuals and suggests that the negative impact of GAHT on spermatogenesis might potentially be reversible. Nevertheless, it is ideal to recommend sperm cryopreservation prior to GAHT as the time it takes to produce viable sperm once GAHT is held is not fully established. Larger studies are needed to confirm our findings which are important for fertility counseling in transgender individuals and to determine the dosing and length of GAHT which may contribute to irreversibility of fertility. Presentation: Sunday, July 13, 2025