FAMILY PLANNING COUNSELING AND PREFERENCES AMONG TRANSGENDER AND GENDER DIVERSE INDIVIDUALS

Professional organizations such as the World Professional Organization for Transgender Health (WPATH) and American Society for Reproductive Medicine (ASRM) recommend all transgender individuals be offered counseling regarding the impact of transition on family planning goals. Furthermore, the ASRM Ethics Committee published a committee opinion suggesting transgender and gender diverse individuals have the same family planning desires as their cis-gender counterparts. This statement appears to be based on studies of fertility desires and intentions among select populations with small sample sizes.2,3 Given the overall low rate of fertility preservation noted in transgender populations, we were interested to see if our multidisciplinary, university-based population differed from previously described populations in regard to interest in family building.4,5 To understand how gender diverse individuals approach family building and the role health care providers play in providing counseling. The UCLA Gender Health Program (GHP) is a multidisciplinary medical, surgical and behavioral health team that supports transgender and gender diverse individuals in their transition. An IRB-exempt survey was created using Qualtrics and disseminated to GHP patients who had indicated prior willingness to participate in research. Descriptive statistics were then performed. Of the 145 patients who agreed to be contacted for research, we received 70 responses to our online survey. The average age was 38.5 years (SD 16.8). Of these, 66% were assigned male at birth and 34% were assigned female at birth. Sexual partner preferences are noted in Table 1. Forty-nine (70%) did not have children. Of the 21 who had children, 13 had biologic (65%), 2 had adopted (10%) and 5 had biologic and adopted children (25%). Interest in having biologic children is demonstrated in Table 2. Twenty-six (53%) did not have children and did not desire biological children in the future. Importance of having biological children is noted in Table 3, with a majority (81%) indicating they felt neutral or against having their own biological child, including those who currently had children. Thirty (44%) were not planning to adopt, twenty-seven (40%) were unsure and eleven (17%) were planning to adopt. Family planning was primarily discussed by primary care providers and medical endocrinologists (Table 4), with a majority (63%) feeling their family planning goals were addressed by medical professionals. A high percentage of transgender and gender diverse individuals in our population state having biological children was not a priority for them, with a majority feeling adequately counseled about family planning by their medical professionals. Nevertheless, family planning desires are important to elicit from gender diverse individuals prior to gender-affirming hormonal or surgical therapies. Larger studies are needed to better understand family planning needs of this population.Table 1Sex Assigned at BirthGametes of Sexual PartnersSpermEggsBothNot Sexually ActiveFemale3939Male1211320 Open table in a new tab Table 2Do you have Children?Interest in future biological childrenTotalYesNoUnsureNo4992613Yes211172 Open table in a new tab Table 3Importance of Having Own Biological ChildTotal #Avg Age (SD 16.8)Very unimportant2144Somewhat important937Neutral2538Somewhat important739Very Important639 Open table in a new tab Table 4Healthcare Professionals who Discussed Family PlanningTotal #%Primary care (internal medicine or family medicine)3449%None1826%Medical endocrinologist1420%Urologist913%Nurse practitioner811%OB/GYN710%General surgeon46%Other34%Plastic surgeon34%Pediatrician11%Reproductive endocrinologist11% Open table in a new tab