(131) Sperm Quality Parameters and Clinical Characteristics of Transgender Females Before Undergoing Gender-Affirming Hormonal Therapy

Introduction Transgender individuals assigned male at birth (AMAB) may opt for fertility preservation before initiating gender-affirming hormone therapy (GAHT), as hormone treatment can impair spermatogenesis. Despite increasing demand for fertility services in this population, there is limited information on their baseline reproductive and hormonal characteristics prior to GAHT, as well as how these parameters change following treatment. Objective To evaluate semen quality in transgender AMAB individuals prior to initiating GAHT and to explore its associations with clinical and hormonal parameters. Additionally, to compare these findings with a small cohort of individuals previously exposed to GAHT. Methods This observational study included 32 treatment-naïve transgender AMAB individuals from two andrology centers who underwent sperm cryopreservation prior to GAHT initiation. Clinical evaluation included anthropometrics, testicular volume measurement, and assessment for varicocele. Hormonal assays measured serum LH, FSH, total testosterone, estradiol, and prolactin. Semen analyses were performed according to WHO reference standards. A comparison was made with 9 transgender AMAB individuals who had previously received GAHT. Results Among treatment-naïve individuals, 46.9% met WHO criteria for normozoospermia. However, a substantial proportion had semen abnormalities: 40.6% had oligozoospermia, 28.1% had asthenozoospermia, and 21.9% had teratozoospermia. Compared to this group, individuals with prior GAHT exposure exhibited significantly higher estradiol levels and lower seminal volume. Although semen abnormalities were more frequent in the previously treated group, the difference was not statistically significant (p > 0.05). Conclusions Nearly half of treatment-naïve transgender AMAB individuals demonstrated abnormal semen parameters even before starting GAHT. Initiation of GAHT was associated with hormonal changes and reduced seminal volume, with a trend toward greater semen quality impairment. These findings underscore the importance of timely fertility counseling and preservation in transgender individuals prior to hormone therapy. Disclosure No