Diane Chen1, Victoria D Kolbuck2, Megan E Sutter3, Amy C Tishelman4, Gwendolyn P Quinn5, Leena Nahata6. 1. Division of Adolescent Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Child and Adolescent Psychiatry, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Departments of Psychiatry and Behavioral Sciences, and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois. Electronic address: DiChen@luriechildrens.org. 2. Division of Adolescent Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois. 3. Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida. 4. Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts. 5. Departments of OB-GYN and Population Health, New York University School of Medicine, New York City, New York. 6. Division of Endocrinology and Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, Ohio; The Ohio State University College of Medicine, Columbus, Ohio.
Abstract
PURPOSE: Transgender individuals may experience impaired fertility due to gender-affirming hormonal interventions (e.g., pubertal suppression treatment and/or exogenous hormones). Clinical practice guidelines recommend providers discuss fertility implications and options for fertility preservation. The goal of this study was to examine fertility knowledge, practice behaviors, and perceived barriers to fertility care among multidisciplinary providers who care for transgender pediatric and/or adult patients. METHODS: A 46-item survey was distributed to relevant listservs and at conferences with a focus on transgender health. RESULTS: Two hundred two providers completed the survey: (1) physicians (n = 87), (2) psychologists (n = 51), (3) Master (MA)-level mental health providers (n = 39), and (4) nonphysician healthcare providers, comprising advanced practice nurses, registered nurses, and physician assistants (n = 25). Overall knowledge was high (M = 3.64, SD = 1.61). Significant differences were identified in knowledge by provider type (p <.001) but not patient age group (p = .693). Physicians had significantly greater knowledge than MA-level mental health providers (p = .005). Variables associated with fertility discussion included provider-related barriers [b = -.42, p < .001], and perceived patient-related barriers, including perceptions that patients are unwilling to delay treatment [b = .12, p = .011] or are unable to afford fertility preservation (FP) [b = .12, p = .029]. CONCLUSIONS: While overall fertility-related knowledge was high, there was variability in domains of knowledge, as well as provider practice behaviors related to fertility counseling and referral for FP. Findings related to perceived barriers to fertility counseling and fertility preservation warrant further investigation; qualitative studies may be particularly helpful in understanding how specific provider- and patient-related barriers impact counseling and referral for fertility-related care.
PURPOSE: Transgender individuals may experience impaired fertility due to gender-affirming hormonal interventions (e.g., pubertal suppression treatment and/or exogenous hormones). Clinical practice guidelines recommend providers discuss fertility implications and options for fertility preservation. The goal of this study was to examine fertility knowledge, practice behaviors, and perceived barriers to fertility care among multidisciplinary providers who care for transgender pediatric and/or adult patients. METHODS: A 46-item survey was distributed to relevant listservs and at conferences with a focus on transgender health. RESULTS: Two hundred two providers completed the survey: (1) physicians (n = 87), (2) psychologists (n = 51), (3) Master (MA)-level mental health providers (n = 39), and (4) nonphysician healthcare providers, comprising advanced practice nurses, registered nurses, and physician assistants (n = 25). Overall knowledge was high (M = 3.64, SD = 1.61). Significant differences were identified in knowledge by provider type (p <.001) but not patient age group (p = .693). Physicians had significantly greater knowledge than MA-level mental health providers (p = .005). Variables associated with fertility discussion included provider-related barriers [b = -.42, p < .001], and perceived patient-related barriers, including perceptions that patients are unwilling to delay treatment [b = .12, p = .011] or are unable to afford fertility preservation (FP) [b = .12, p = .029]. CONCLUSIONS: While overall fertility-related knowledge was high, there was variability in domains of knowledge, as well as provider practice behaviors related to fertility counseling and referral for FP. Findings related to perceived barriers to fertility counseling and fertility preservation warrant further investigation; qualitative studies may be particularly helpful in understanding how specific provider- and patient-related barriers impact counseling and referral for fertility-related care.
Authors: Amy C Tishelman; Megan E Sutter; Diane Chen; Amani Sampson; Leena Nahata; Victoria D Kolbuck; Gwendolyn P Quinn Journal: J Assist Reprod Genet Date: 2019-01-03 Impact factor: 3.412
Authors: Timothy Chwan Lai; Cristyn Davies; Kerry Robinson; Debi Feldman; Charlotte Victoria Elder; Charlie Cooper; Ken C Pang; Rosalind McDougall Journal: BMJ Open Date: 2021-05-19 Impact factor: 2.692
Authors: Selena U Park; Devika Sachdev; Shelley Dolitsky; Matthew Bridgeman; Mark V Sauer; Gloria Bachmann; Juana Hutchinson-Colas Journal: F S Rep Date: 2022-07-19