Semen Quality in Transgender Individuals Seeking Fertility Preservation

Maurizio De Rocco Ponce; Eden Troka; Massimiliano Raffo; Luis Miguel Malca Caballero; Alberto Ferlin; Andrea Salonia; Eduard Ruiz Castañé; Alberto Scala; Andrea Garolla; Gender Incongruence Interdisciplinary Group (GIIG)

doi:10.1111/andr.70268

Male Fertility · Semen Analysis

Semen Quality in Transgender Individuals Seeking Fertility Preservation

Ponce MR, Troka E, Raffo M, Caballero LMM, Ferlin A, Salonia A, Castañé ER, Scala A, Garolla A, Gender Incongruence Interdisciplinary Group (GIIG)

Published September 2026 Andrology

DOI 10.1111/andr.70268 PMID 42338401 PMC PMC13432531

RRM Academy Synopsis

Many transgender AMAB individuals had impaired semen before hormones

In this retrospective study, abnormal semen affected 53 out of 100 transgender participants versus 25 out of 100 healthy young cisgender controls. The 32 participants, all assigned male at birth (AMAB), froze sperm before gender-affirming hormone therapy (GAHT). Their hormone levels were generally within reference ranges.

Key Findings

Of 32 treatment-naïve participants, 15 (46.9%) had normozoospermia, meaning normal semen by WHO criteria. Thirteen had some degree of oligozoospermia (low sperm count).
Seminal abnormalities were more frequent in treatment-naïve transgender participants than in cisgender controls (53% vs. 25%, p = 0.004), with significantly lower values on all major sperm measures except seminal volume.
No treatment-naïve participant had hypogonadism, though 5 (15.6%) had borderline testosterone. Higher FSH levels correlated inversely with sperm concentration, total count and morphology.
Nine previously treated participants, who had stopped GAHT at least 3 months earlier, had lower seminal volume and higher estradiol than treatment-naïve participants.
Seminal abnormalities were more frequent among previously treated participants than treatment-naïve ones (67% vs. 47%, p = 0.370), a difference that did not reach statistical significance.

Interpretation

The study is retrospective and observational. Two andrology centers supplied 32 treatment-naïve participants and 9 previously treated participants. Controls came from a blood donation center. Smoking, alcohol use, BMI and varicocele showed no significant correlation with semen quality in this sample. Participants were significantly older than controls, a gap the authors judge unlikely to be clinically meaningful. The authors ran no formal power calculation, and the previously treated group was small with varied regimens. The authors state that the cross-sectional design precludes conclusions about cause or long-term recovery of sperm production. They conclude that the findings support guidelines recommending fertility preservation before GAHT.

RRM Context

Restorative reproductive medicine looks for the cause of low semen quality before treating it. The authors report that the causes of these abnormalities remain unclear.

Our editorial summary of this paper, not the article's abstract.

Abstract

Background

Transgender individuals assigned male at birth (AMAB) may choose to preserve their fertility prior to starting gender-affirming hormone therapy (GAHT). However, limited data exist regarding the baseline reproductive and hormonal characteristics of this population before and after GAHT.

Objectives

To characterize semen quality and hormonal profiles in transgender AMAB individuals prior to GAHT and compare findings with cisgender men and with transgender individuals who discontinued GAHT for at least 3 months.

Materials and Methods

This retrospective study included transgender AMAB individuals from two tertiary andrology centers who underwent sperm cryopreservation before GAHT initiation (treatment-naïve group). Clinical evaluation included anthropometric measures, testicular volume assessment, varicocele detection, and sex hormone measures. Semen parameters were analyzed according to WHO criteria and compared with those of cisgender men and previously treated transgender individuals.

Results

Thirty-two treatment-naïve transgender AMAB individuals were included. Hormonal parameters were generally within reference ranges. Only 46.9% of treatment-naïve individuals met WHO criteria for normozoospermia, compared with 75.5% of cisgender controls. Compared with nine previously treated individuals, estradiol levels were higher and seminal volume lower. A higher frequency of seminal abnormalities was observed, although not statistically significant.

Conclusions

A substantial proportion of treatment-naïve transgender AMAB individuals exhibited impaired semen parameters prior to GAHT initiation. Prior GAHT exposure showed a trend toward poorer semen quality. These findings support early fertility counseling and preservation in transgender individuals prior to GAHT initiation.

Topics

Male Fertility › Semen Analysis › Reference Standards · Diagnostics › Hormone Testing › Serum Panels · Ethics and Policy › Reproductive Ethics › LGBTQ Rights

Maurizio De Rocco Ponce, Eden Troka, Massimiliano Raffo, Luis Miguel Malca Caballero, Alberto Ferlin, Andrea Salonia, Eduard Ruiz Castañé, Alberto Scala, Andrea Garolla

M Ponce, E Troka, M Raffo, L Caballero, A Ferlin, A Salonia, E Castañé, A Scala, A Garolla

PMID 42338401 42338401 DOI 10.1111/andr.70268 10.1111/andr.70268 Ponce et al. 2026, Ponce 2026

Semen Quality in Transgender Individuals Seeking Fertility Preservation

Many transgender AMAB individuals had impaired semen before hormones

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

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