ABSTRACT
Transgender and nonbinary (TGNB) individuals are an underserved population in reproductive healthcare, with increased research, education, and advocacy required to improve access and quality of fertility care for this community. While there is consensus regarding the importance of fertility preservation counselling prior to initiation of gender-affirming medical or surgical treatments, in practice, fertility preservation is inconsistent and often inadequate. Current evidence of the impact of gender-affirming hormones on ovarian and testicular function show variable results with potential for a detrimental effect on an individual's reproductive capacity. Case series of assisted reproductive technology (ART) outcomes in TGNB individuals show promising results but many critical questions remain unanswered. Further research is necessary to improve understanding of the impact of gender-affirming hormones on an individual's reproductive function and their future offspring, determine whether this impact has reversibility, and formulate optimal treatment strategies for TGNB individuals desiring genetically related children.
