When ‘Affirmation’ Means Sterilization
Most youth report wanting children someday, yet very few take steps to protect their fertility before medical transition. A new study reveals why.
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About the Author
Dr. Colin Wright is an evolutionary biology PhD, Manhattan Institute Fellow, and CEO/Editor-in-Chief of Reality’s Last Stand. His writing has appeared in The Wall Street Journal, The Times, the New York Post, Newsweek, City Journal, Quillette, The Washington Examiner, and other major news outlets and scientific journals.
Over the past decade, pediatric “gender-affirming care” has been adopted widely in clinical settings despite a remarkably weak evidence base. Systematic reviews from several countries have consistently found that the research supporting puberty blockers, cross-sex hormones, and related interventions in minors is of low quality, lacking reliable long-term data on physical or psychological outcomes. Meanwhile, the severe and often irreversible side effects of these treatments are well documented. Chief among them is the loss of fertility.
Because of this risk, clinical guidelines recommend that adolescents be counseled about infertility and offered fertility preservation before beginning medical transition. In theory, this gives them the choice to protect their ability to have biological children in the future. In practice, however, only a vanishingly small number of “transgender and gender-diverse” (TGD) adolescents actually pursue fertility preservation, even when counseling is provided.
This creates an odd set of seemingly contradictory facts. Survey-based studies show that while few adolescents choose to preserve their fertility, a significant number hope to become parents later in life. Follow-up studies of adults who began medical transition as teenagers confirm that the desire for children often increases with age, leaving many to deeply regret not preserving their fertility when they had the chance.
Until now, research has failed to explain exactly where the drop-off occurs between a patient expressing interest in future children and actually completing the preservation process. It has also remained unclear whether these abysmally low rates reflect genuine personal preference, or practical barriers such as high cost and the complexity of the procedures involved.
A new retrospective cross-sectional study published in the Journal of Pediatric and Adolescent Gynecology helps clarify this issue by tracking patients from their first counseling visit through referral, specialist consultation, and—if it occurred—completion of a fertility preservation procedure.
