Transgender people refer to a diverse group of people who identify with a gender incongruent with one assigned at birth. The 2011 census recorded about five lac transgender people in India, a number that is likely vastly undercounted.[1] Similarly, up to 1.6 million people in the United States have been reported to be transgender. A population prevalence of 0.2%–0.6% has been reported in the UK.[2]
Research into the health concerns of the transgender community is scanty. It is well known that general practitioners and healthcare professionals are ill-trained and ill-equipped in dealing with the problems of the transgender community. The profound gender dysphoria that some transgender people experience can make them hesitant to participate in screening programs and clinical examinations at times. With liberties that the transgender movement has acquired over the last few years, the true reported number of transgender people is likely to increase.
A large proportion of transgender population may feel the need to bring up children. However, self-medication is known to be rampant among the transgender population. Surgical procedures aimed at gender re-assignment are frequently taken by the population.[3,4]
Hormonal treatments that transgender people undergo can have negative effects on fertility. Even some surgical procedures such as hysterectomy and oophorectomy can lead to irreversible infertility.[5]
Clinicians dealing with trans-people have an ethical responsibility to counsel them regarding fertility preservation. Fertility preservation procedures in trans-men as well as trans-women are likely going to increase. Options include embryo, oocyte, and ovarian tissue cryopreservation for trans-men and sperm or testicular cryopreservation for trans-women. Surgical uterine transplantation has been successfully performed in cis-gender women and may emerge as a novel future option in trans-population as well.[4,5]
In the near future, the number of transgenders presenting to reproductive medicine practice is likely to increase drastically. It is imperative that infertility physicians be well-trained and equipped not just with clinical skills but with adequate moral, ethical, and social skills to deal with the population in a respectful way. Only then can we fully integrate them into our society.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
REFERENCES
1. Majumder A, Roychaudhuri S, Chakraborty S, Bhattacherjee K. An observational study of the quality of life among gender incongruent individuals from “Hijra” community of India Indian J Endocrinol Metab. 2020;24:301–5
2. Meerwijk EL, Sevelius JM. Transgender population size in The United States: A meta-regression of population-based probability samples Am J Public Health. 2017;107:e1–8
3. Cheng PJ, Pastuszak AW, Myers JB, Goodwin IA, Hotaling JM. Fertility concerns of the transgender patient Transl Androl Urol. 2019;8:209–18
4. Tornello SL, Bos H. Parenting intentions among transgender individuals LGBT Health. 2017;4:115–20
5. Kent MA, Winoker JS, Grotas AB. Effects of feminizing hormones on sperm production and malignant changes: Microscopic examination of post orchiectomy specimens in transwomen Urology. 2018;121:93–6
