(021) Fertility and Contraception Counseling for Transmasculine Patients Initiating Gender-Affirming Therapy: Insights from Thematic Analysis

Introduction Fertility preservation and contraception counseling are critical elements of comprehensive care for transmasculine individuals initiating masculinizing hormone replacement therapy (HRT) and prior to gender-affirming procedures such as phalloplasty, metoidioplasty, hysterectomy, vaginectomy, and salpingo-oophorectomy. However, limited qualitative research captures patient perspectives on the quality and content of their reproductive health counseling. Objective We aimed to characterize transmasculine individuals’ experiences with fertility preservation and contraception counseling prior to HRT initiation and genital gender-affirming surgery. Methods We conducted a cross-sectional survey of 280 transmasculine individuals on masculinizing HRT. Responses to closed- and open-ended questions regarding fertility preservation and contraception counseling were analyzed via descriptive statistics and thematic analysis, respectively. Results Counseling was reported to be of poor quality or absent by 61 (21.7%) for fertility preservation and 47 (16.8%) for contraception. Twenty-four (8.6%) reported never being informed by a provider that it is possible to conceive a pregnancy while on testosterone HRT. Four major themes emerged: (1) Adequate counseling, where participants described informative and supportive discussions aligned with their goals; (2) Perceived irrelevance, where counseling was absent or minimal due to lack of interest in childbearing or sexual activity that could result in conception; (3) Socioeconomic barriers, where cost, limited insurance, or stigma prevented access to fertility preservation or preferred contraception regardless of counseling quality; and (4) Inadequate or misleading counseling, where discussions were absent, minimal, or inaccurate (e.g. being told HRT would cause permanent infertility). Representative quotes are included in Table 1. Conclusions Transmasculine individuals describe inconsistent counseling on fertility preservation and contraception at the time of HRT initiation. Misinformation and lack of discussion, particularly the misconception that testosterone prevents pregnancy, pose significant risks. Development of standardized, inclusive, and accessible counseling protocols is essential to support reproductive autonomy in this population. Disclosure No