Electronic Thesis and Dissertation Repository

Thesis Format



Master of Science


Epidemiology and Biostatistics


Bauer, Greta R.


Background. Prevalence of fertility preservation discussions and procedures, participant characteristics associated with discussions, and prevalence of desire to parent are described.

Methods. Describes, for a clinical sample of < 16-year-olds: medical chart-recorded discussion and procedure prevalence, and desire to parent longitudinally. Describes self-reported discussion prevalence for a community sample of 14- to 39-year-olds. Bivariate and multivariable modified Poisson analyses were conducted for this sample.

Results. Discussion prevalence was confirmed for approximately 80% of the clinical sample, with approximately 20% unconfirmed. Self-reported discussion prevalence was 45% in the community sample. Non-binary gender with female sex at birth, greater family religiosity, and diagnosed mental health condition excluding depression or anxiety were crudely associated with less discussions. Multivariable analyses revealed no statistically significant predictors. Desire to parent was fairly consistent over time.

Conclusion. Discussions should be standard practice for all fertile patients pursuing medical gender affirmation.

Summary for Lay Audience

A transgender person may pursue a variety of social, physical, medical, and legal avenues for gender affirmation. Broadly, these create congruence between their experience of their gender, and how their gender is perceived by others.

Medical gender affirmation requires contact with the healthcare system. This includes obtaining prescriptions for hormone suppressant medication, hormones to promote development of secondary sex characteristics, and surgeries, which typically follow the initiation of hormone therapy. Some (typically surgical) medical gender affirmation can be permanently sterilizing. Research suggests that hormonal gender affirmation, the focus of this thesis, can also decrease fertility.

The World Professional Association for Transgender Health recommends fertility preservation counselling prior to beginning medical gender affirmation. The idea of fertility preservation generally receives strong support from the transgender community. However, actual utilization of fertility preservation procedures is much lower, and is less common among people whose sex at birth is female.

Delaying medical gender affirmation frequently produces emotional burden, one of many barriers that can prevent transgender people from pursuing fertility preservation. The barrier upon which this thesis focuses is that fertility preservation discussions with healthcare providers are not standard practice prior to beginning medical gender affirmation.

This thesis uses data from two different populations: a clinical sample of transgender youth < 16 years old accessing medical gender affirmation, and a community sample of transgender individuals 14- to 39-years-old.

In this study, approximately 80% of the clinical sample were confirmed to have discussed fertility preservation prior to beginning medical care, with the rest unconfirmed. 74% of youth in the clinical sample declined fertility preservation procedures. Self-reported discussion prevalence for the community sample was approximately 45%. In the community sample, non-binary gender with female sex at birth, greater family religiosity, and diagnosed mental health condition excluding depression or anxiety were crudely associated with less fertility preservation discussions.

Desire to parent was found to be fairly stable over time, with a greater proportion of youth age 10 to 13 being unsure of their future parenting desires.

Available for download on Friday, December 22, 2023

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