Maintaining Testosterone Therapy Throughout Ovarian Stimulation for Trans Masculine Individuals: A Systematic Review

PURPOSE: This systematic review aimed to summarize evidence on continuous testosterone therapy during ovarian stimulation in trans masculine individuals. METHODS: A search of Medline, EMBASE, Cochrane, PubMed, CINAHL, Web of Science, and ClinicalTrials.gov was conducted through October 2024 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies reporting ovarian stimulation on continuous testosterone therapy were included. The Joanna Briggs Institute Checklist for Case Reports was used to assess risk of bias, and descriptive statistics and qualitative synthesis were conducted. RESULTS: The review included six articles involving eight patients. Median age at oocyte cryopreservation was 27 years (range 20-34), and median age at initiation of testosterone was 24 (range 18-27). An antagonist protocol was used for seven patients. Letrozole was given to three patients during their cycle. Oocytes were cryopreserved for four patients, embryos were cryopreserved at the time of stimulation for two patients, and two patients created embryos from cryopreserved oocytes. The median number of oocytes retrieved from seven patients was 20 (range 13-56), and the median number of oocytes cryopreserved from six patients was 22.5 (range 9-30). To date, three embryo transfers (two frozen and one fresh) have been reported, all resulting in live births. CONCLUSION: Live births, oocyte and embryo cryopreservation, are possible across a range of stimulation protocols under testosterone exposure. As trans masculine patients report gender dysphoria with the fertility preservation process, these case reports present an opportunity for reconsideration of current practices and propose a paradigm shift in fertility care for transgender individuals.