Fertility Decision-Making in Youth and Young Adults

帮助跨性别青年与家人就保持生育能力进行复杂的讨论， 治疗小组是必要的，以促进知情决策，并最终保护他们的生殖健康。 自治越来越多的跨性别青年寻求性别确认激素（GAH;雌激素）治疗 和睾丸激素）来调整他们的身体与他们的性别认同。GAH在医学上适用于治疗性别 烦躁不安（即，由于出生性别和性别认同之间的不匹配而造成的痛苦）。但长期 GAH的使用可能会损害生育潜力，从而限制未来的生殖选择。生育力保持（FP） 为寻求GAH的跨性别青年提供了在未来拥有亲生子女的机会。决策 FP是复杂的，因为：（1）临床阈值尚未建立多少GAH暴露 将导致对生育能力的永久性负面影响，（2）儿科FP选择和辅助生殖 技术（ART）是复杂和快速发展的，（3）跨性别青年必须考虑养育意图 虽然青年可能没有准备好参与计划生育的决定，（4）受损 生育率影响未来的生活质量，而不是目前的功能或生存。最近的研究表明， 超过5%的跨性别青年尽管接受常规咨询和转介到生育诊所，但仍追求FP。此外，委员会认为， 我们的初步数据表明，跨性别青年缺乏GAH对生育力和FP影响的具体知识 选项.因此，跨性别青年正在做出对其生殖健康有长期影响的决定。 基于对生殖生物学、GAH效应的不完全知识和理解的健康和自主性 生育率和计划生育方案。总的来说，这表明目前的生育咨询方案可能不会 满足患者对知情决策的需求。这项研究的目的是培养一个病人- 针对跨性别青年的生育相关医疗决策援助（AFFRMED）和试点测试 前/后测试设计中AFFRMED对知识的可行性、可接受性和有效性。成功 本研究的完成将产生一个基于网络的AFFRMED原型，该原型将：（1）促进以患者为中心的 就未来生育率的复杂和敏感问题进行沟通，（2）帮助变性青年， 他们的父母在做出可能影响未来生育能力的医疗决定时的困难，以及（3） 在不断发展的抗逆转录病毒疗法的背景下，促进关于计划生育的知情决策。

Helping transgender youth engage in complex discussions about fertility preservation with their families and treatment teams is necessary to foster informed decision-making and to ultimately protect their reproductive autonomy. Transgender youth increasingly seek treatment with gender-affirming hormones (GAH; estrogen and testosterone) to align their bodies with their gender identity. GAH are medically indicated to treat gender dysphoria (i.e., distress due to a mismatch between birth-assigned sex and gender identity). But long-term GAH use may compromise fertility potential, thus limiting future reproductive options. Fertility preservation (FP) offers transgender youth seeking GAH the opportunity to have biological children in the future. Decisions about FP are complicated because: (1) clinical thresholds have not been established for how much GAH exposure will result in permanent negative effects on fertility, (2) pediatric FP options and assisted reproductive technologies (ART) are complex and rapidly evolving, (3) transgender youth must consider parenting intentions although youth may not be developmentally ready to engage in family planning decisions, and (4) impaired fertility affects future quality of life, rather than current functioning or survival. Recent studies show that less than 5% of transgender youth pursue FP despite routine counseling and referral to fertility clinics. Moreover, our preliminary data suggest that transgender youth lack specific knowledge of GAH effects on fertility and FP options. Thus, transgender youth are making decisions that have long-term implications on their reproductive health and autonomy based on incomplete knowledge and understanding of reproductive biology, GAH effects on fertility, and FP options. Taken together, this suggests that current protocols for fertility counseling may not be meeting patients’ needs for informed decision-making. The goals of this study are to develop a patient- centered Aid For Fertility-Related Medical Decisions (AFFRMED) targeted for transgender youth, and pilot test the feasibility, acceptability, and efficacy of the AFFRMED on knowledge in a pre-/post-test design. Successful completion of this study will result in a web-based AFFRMED prototype that will: (1) foster patient-centered communication regarding complex and sensitive issues about future fertility, (2) aid transgender youth and their parents in making difficult decisions about medical treatment that may affect future fertility, and (3) facilitate informed decision-making about FP in the context of evolving ART.