New tool captures fertility knowledge and attitudes in transgender youth

A novel tool developed by researchers at Children's National Health System-with critical input from transgender youth and their parents-assesses the level of interest or concern these teens and their families have regarding the impacts of medical gender treatments on long-term fertility.

The Transgender Youth Fertility Attitudes Questionnaire and its pilot study appear in the Journal of Adolescent Health. Designed using a first-of-its-kind process that engaged transgender youth in the development of questions, the questionnaire seeks to gather data to help clinicians better support transgender teens.

"When we are talking about treatments that may be lifesaving to a transgender person, we also discuss the ways it could change their life," says John Strang, Psy.D., a neuropsychologist at Children's National Health System and lead author of the study. "Gender-related medical approaches may impact fertility for a lifetime—and while it may not matter to someone now, it might in the future. This new tool will help us understand how our youth feel about these issues and questions, so we know when it is appropriate to discuss choices."

The Tool

The brief survey is designed for everyday clinical and research settings, and it specifically captures teen and parent:

• Knowledge about fertility risks from medical gender treatments
• Thoughts and feelings about importance of having biological children
• Knowledge and intentions for fertility preservation procedures

The attitudes questionnaire builds on existing approaches and measures developed to assess fertility attitudes in youth at risk for infertility, with questions tailored for the transgender youth population. The process of developing the measure followed a novel nine step iterative participatory process geared specifically to transgender teens, including the autistic subpopulations within that group, representing up to a quarter of youth gender referrals.

"Engaging these kids and their families in developing these measures from the outset by asking for their input on language preferences and sensitive topics, helped us to maximize its relevance for the community. We hope that the final questionnaire, and the process that designed it, will serve as a model for questionnaire development for transgender youth," continues Dr. Strang.

The result is a single tool that clinicians and researchers can use to assess fertility attitudes for transgender youth contemplating medical gender treatments. The tool is free and available on the Children's National website.

Pilot Study Results

The pilot study of the tool, published as part of the journal article, found that a majority of transgender youth expressed a wish to have children someday, though only 24 percent expressed a desire for that child to be biologically theirs. Importantly, many youth wondered, or didn't know, if their feelings about having a biological child might change in the future.

"Though we know that in general not many youth undergoing medical gender treatments take advantage of fertility preservation at present, this tool helps us to ask important questions that ensure we are able to offer these services to the people who would benefit from knowing their biological options remain viable in the future," adds Veronica Gomez-Lobo, M.D., the study's senior author and a pediatric and adolescent gynecologist at Children's National who specializes in gender and sexuality development.