Ovarian stimulation for fertility preservation or family building in a cohort of transgender men



The purpose of this study was to compare ovarian stimulation and pregnancy outcomes between transgender men (1) with and without a history of testosterone use (HRT) and (2) to cisgender women.


Retrospective chart review between January 1st 2015 and March 1st, 2019 of transgender men and cisgender women seeking ovarian stimulation (OS) matched by BMI and age. Outcomes were compared using Fisher’s exact or Wilcoxon’s rank sum tests.


Thirteen transgender men presented for OS, 7 who used HRT. When comparing transgender men with and without a history of HRT, there were no differences in the baseline follicle count, cycle length, or FSH and hmG used (p = 0.193, 0.306, 0.200, and 0.197, respectively). Transgender men who used HRT had lower peak estradiol and oocytes retrieved compared to transgender men with no HRT use; peak estradiol levels of 1175 pg/mL IQR [559.5–2684]) vs 2713.5 pg/mL IQR [2335–3105]; oocytes retrieved 12 IQR [4–26]) vs. 25.5 [18–28] (p = 0.046. and 0.038, respectively). There were no differences in the estradiol level per oocyte, meiosis II oocyte yield, or maturity rate (MII/oocytes) between the two groups (p = 1.000, 0.148, and 0.147, respectively). Peak estradiol levels were lower among transgender men compared to cisgender women (p = 0.016), but the remaining cycle characteristics were similar between the two groups. Three successful pregnancies were conceived using the oocytes of transgender men who used HRT.


HRT use may not negatively impact ovarian stimulation outcomes. Clinical pregnancies are possible from the oocytes of transgender men with a history of HRT.

This is a preview of subscription content, access via your institution.


  1. 1.

    Schneider F, Kliesch S, Schlatt S, Neuhaus N. Andrology of male-to-female transsexuals: influence of cross-sex hormone therapy on testicular function. Andrology. 2017;5(5):873–80.

    CAS  PubMed  Article  Google Scholar 

  2. 2.

    Ikeda K, Baba T, Noguchi H, Nagasawa K, Endo T, Kiya T, et al. Excessive androgen exposure in female-to-male transsexual persons of reproductive age induces hyperplasia of the ovarian cortex and stroma but not polycystic ovary morphology. Hum Reprod. 2013;28(2):453–61.

    CAS  PubMed  Article  Google Scholar 

  3. 3.

    Hembree WC, Cohen-Kettenis P, Delemarre-van de Waal HA, Gooren LJ, Meyer WJ III, Spack NP, et al. Endocrine treatment of transsexual persons:an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2009;94(9):3132–54.

    CAS  Article  Google Scholar 

  4. 4.

    Coleman E, Bockting W, Botzer M, Cohen-Kettenis P, DeCuypere G, Feldman J, et al. Standards of Care for the Health of transsexual, transgender, and gender-nonconforming people, version 7. Int J Transgenderism. 2012;13(4):165–232.

    Article  Google Scholar 

  5. 5.

    Martinez F, International Society for Fertility Preservation–ESHRE–ASRM Expert Working Group. Update on fertility preservation from the Barcelona International Society for Fertility Preservation-ESHRE-ASRM 2015 expert meeting: indications, results and future perspectives. Fertil Steril. 2017;108(3):407–415.e11.

    PubMed  Article  Google Scholar 

  6. 6.

    Light AD, Obedin-Maliver J, Sevelius JM, Kerns JL. Transgender men who experienced pregnancy after female-to-male gender transitioning. Obstet Gynecol. 2014;124(6):1120–7.

    CAS  PubMed  Article  Google Scholar 

  7. 7.

    Maxwell S, Noyes N, Keefe D, Berkeley AS, Goldman KN. Pregnancy outcomes after fertility preservation in transgender men. Obstet Gynecol. 2017;129(6):1031–4.

    PubMed  Article  Google Scholar 

  8. 8.

    Armuand G, Dhejne C, Olofsson JI, Rodriguez-Wallberg KA. Transgender men’s experiences of fertility preservation: a qualitative study. Hum Reprod. 2017;32(2):383–90.

    CAS  PubMed  Article  Google Scholar 

  9. 9.

    De Roo C, et al. Ovarian tissue cryopreservation in female-to-male transgender people: insights into ovarian histology and physiology after prolonged androgen treatment. Reprod BioMed Online. 2017;34(6):557–66.

    PubMed  Article  Google Scholar 

  10. 10.

    Lierman S, Tilleman K, Braeckmans K, Peynshaert K, Weyers S, T’Sjoen G, et al. Fertility preservation for trans men: frozen-thawed in vitro matured oocytes collected at the time of ovarian tissue processing exhibit normal meiotic spindles. J Assist Reprod Genet. 2017;34(11):1449–56.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  11. 11.

    Leung A, Sakkas D, Pang S, Thornton K, Resetkova N. Female to male transgender patients have good egg yields with controlled ovarian hyperstimulation. Fertil Steril. 2018;110(4):e21–2.

    Article  Google Scholar 

  12. 12.

    Caanen MR, Soleman RS, Kuijper EAM, Kreukels BPC, de Roo C, Tilleman K, et al. Antimüllerian hormone levels decrease in female-to-male transsexuals using testosterone as cross-sex therapy. Fertil Steril. 2015;103(5):1340–5.

    CAS  PubMed  Article  Google Scholar 

  13. 13.

    Grynberg M, Fanchin R, Dubost G, Colau JC, Brémont-Weil C, Frydman R, et al. Histology of genital tract and breast tissue after long-term testosterone administration in a female-to-male transsexual population. Reprod BioMed Online. 2010;20(4):553–8.

    CAS  PubMed  Article  Google Scholar 

  14. 14.

    Bentz E-K, Hefler LA, Kaufmann U, Huber JC, Kolbus A, Tempfer CB. A polymorphism of the CYP17 gene related to sex steroid metabolism is associated with female-to-male but not male-to-female transsexualism. Fertil Steril. Jul. 2008;90(1):56–9.

    CAS  PubMed  Article  Google Scholar 

  15. 15.

    Light A, Wang L-F, Zeymo A, Gomez-Lobo V. Family planning and contraception use in transgender men. Contraception. 2018;98(4):266–9.

    PubMed  Article  Google Scholar 

  16. 16.

    Perrone AM, Armillotta F, Formelli G, Casadio P, Salfi NCM, Badiali de Giorgi L, et al. T04-O-05 high dose testosterone (T) treatment has no adverse effects on the endometrium of female to male transsexuals (FtM). Sexologies. 2008;17:S78–9.

    Article  Google Scholar 

  17. 17.

    Grant J, Mottet L, Tanis J, Herman J, Harrison J, Keisling M. National Transgender Discriminiation SUrvey report on health and health care. National Center for Transgender Equality; 2010.

Download references

Financial support


Author information



Corresponding author

Correspondence to Amanda J. Adeleye.

Ethics declarations


Amanda Adeleye is a shareholder of Carrot. The remaining authors have nothing to disclose.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Adeleye, A.J., Cedars, M.I., Smith, J. et al. Ovarian stimulation for fertility preservation or family building in a cohort of transgender men. J Assist Reprod Genet 36, 2155–2161 (2019). https://doi.org/10.1007/s10815-019-01558-y

Download citation


  • Transgender
  • Fertility preservation
  • Transgender men