Reproductive Consequences of Steroid Administration
The impact of long-term gender-affirming hormone therapy on the reproductive health of transgender individuals is largely unknown. National and international medical organizations recommend fertility preservation counseling prior to starting gender-affirming hormone therapy, but these recommendations are based on an assumption of loss of fertility, not data. For both adult and peripubertal treatment strategies, it is unknown if the effects of gender-affirming treatment on reproductive function can be completely reversed, partially reversed, or if fertility preservation is the best means for safeguarding future fertility potential. We have developed mouse models mimicking gender-affirming hormone therapy paradigms, which we are using to investigate reproductive impact and reversibility in a manner not feasible in humans. These models allow for future studies comparing duration and reversibility of T-induced changes, on the reproductive and other systems. It supports a role for T therapy in suppressing the hypothalamic-pituitary-gonadal axis in adult female mice as evidenced by LH suppression, persistent diestrus, and absence of corpora lutea. The increase in atretic cyst-like late antral follicles aligns with the increased prevalence of polycystic ovary morphology seen in case series of transgender men treated with T therapy. The results also suggest that T therapy does not deplete the ovarian reserve. More details can be found in our recent publications.