A 26-year-old healthy transgender female with gender dysphoria presented for consideration
of gender-affirming vaginoplasty with simultaneous orchiectomy. She had been living
as a female for 19 months and started hormone treatment with estrogen injections and
oral spironolactone 16 months prior to presentation. After discussion of gender-affirming
surgery including bilateral orchiectomy, the patient endorsed interest in sperm cryopreservation.
Approximately 2 months prior to surgery, she stopped her estrogen and spironolactone.
She began a regimen of 75 units Follitropin Alfa (FSH) 3 times weekly and 25 mg oral
clomiphene citrate (Clomid) daily. In the subsequent 6 weeks, the patient experienced
recovery of her testosterone levels and had evidence of motile sperm on semen analysis
(Tables 1 and 2). Ejaculatory semen samples were cryopreserved and the patient resumed her estrogen
therapy before proceeding with gender-affirming surgery 2 weeks later.
Table 1Semen analyses for cryopreservation collected at 6 weeks (SA#1), 8 weeks (SA#2), and
10 weeks (SA#3) after stopping estrogen and starting treatment with FSH and clomiphene
citrate
| Semen Analysis #1 | Semen Analysis #2 | Semen Analysis #3 | |
|---|---|---|---|
| Days abstinent | 3 | 5 | 1 |
| pH | 7.6 | 8.0 | 7.6 |
| Volume | 0.5 mL | 1.2 mL | 0.5 mL |
| Concentration | 16 million/mL | 12 million/mL | 20 million/mL |
| Total number | 8 million | 14 million | 10 million |
| Progressive motility | 53% | 59% | 61% |
| Nonprogressive motility | 4% | 5% | 6% |
| Immotile | 43% | 36% | 33% |
| Total progressive motile | 4 million | 8 million | 6 million |
| Normal morphology | 2% | 3% | 2% |
Table 2Lab values prior to starting hormone treatment (baseline), 2-10 months before stopping
hormone treatment, and at time of last semen sample for cryopreservation (10 weeks
after stopping hormone treatment and starting combination therapy)
| Timing of Serum Testing | Testosterone (Free/Total) (ng/dL) | Estradiol (pg/mL) | FSH (IU/mL) |
|---|---|---|---|
| Baseline (before feminizing hormones) | 22.4/747 | ||
| 10 months precryopreservation | 1.1/86 | 61 | |
| 6 months precryopreservation | 0.35/19 | 153 | |
| 2 months precryopreservation | 0.18/11 | <0.2 | |
| Date of last semen analysis | X/590 | 29 | 1.3 |
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Article info
Publication history
Published online: August 26, 2019
Accepted:
August 14,
2019
Received:
August 5,
2019
Footnotes
Disclosures: The authors declare that they have nothing to disclose.
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
