Parental perspectives on fertility preservation for their trans and gender-expansive children: Reflections on complexities of autonomy, support, and societal realities

Introduction: Navigating fertility preservation poses unique challenges for young transgender and gender expansive (TGE) youths, who must balance short-term concerns like delaying gender-affirming hormonal treatment (GAHT) with long-term considerations of potential infertility. Parents play a crucial role in supporting their TGE children through their gender affirmation journey, which includes discussions about fertility preservation. Aim: This study aimed to explore parental feelings and attitudes toward the fertility preservation of their TGE children, acknowledging the diverse perspectives shaped by societal, legal, and personal factors. Methods: The study involved 82 parents who completed an online-distributed questionnaire. Participants were parents of TGE youths aged between six and twenty-five years old. The mixed-methods study utilized a tailored questionnaire comprising both open-ended and closed-ended questions. Results: Descriptive analysis revealed that a significant majority of parents were aware of the effects of GAHT on fertility, with 65.3% expressing a desire for their children to have their own children in the future. However, parents shared that only 14.5% of children underwent a fertility preservation pathway, while 68.1% did not, citing barriers such as lack of services, cost, and procedural distress. Qualitative analysis identified four main themes: (1) Emotional response, (2) Parental expectations, (3) Parent-Child relationship, and (4) Structural barriers. Discussion: Overall, the study underscores the multifaceted nature of parental experiences regarding fertility preservation for TGE individuals, emphasizing the importance of addressing societal norms, personal expectations, and structural barriers to ensure equitable access to reproductive healthcare services.