Perspectives of Transgender and Gender Diverse People on Fertility Preservation and Future Biological Family Building: A European Network for the Investigation of Gender Incongruence Study

Purpose: This study examined the perspectives of transgender and gender diverse (TGD) people on fertility preservation and future biological family building at the initiation of gender-affirming hormone therapy (GAHT), aiming to enhance counseling practices and support informed decision-making. Method: This international multicenter questionnaire study was conducted as part of the European Network for the Investigation of Gender Incongruence across four outpatient clinics in four countries. Participants completed a fertility questionnaire at the initiation of GAHT from January 2017 to June 2023. Results: Of 661 participants, 58% were assigned female at birth (AFAB) and 42% assigned male at birth (AMAB). Most received information on GAHT’s effects on fertility (78%), with 36% expressing a (future) desire for parenthood, biologically or otherwise. Cryopreservation rates for people AFAB were 7% and 24% for people AMAB. The most common reason for not freezing gametes was not finding it necessary, in both people AFAB and AMAB. Conclusions: Our study shows that many TGD individuals desire to parent children. However, they do not always consider a biological relation a necessity. This partly explains the low uptake of fertility preservation.