150 Chapter 8 from Islamic countries felt more distress because of infertility than Caucasian women. A survey among transgender adolescents also found that minors of colour expressed an interest in having biological children more often than white non-Hispanic/Latino minors (Chen et al., 2018). It is uncertain to what extent other relevant issues identified in previous studies, such as stigma towards sexual and gender minority parenting and pressure from one’s family to have biological children or the feeling of disappointing one’s family by not having biological children played a role in the population included in the present study (Chen et al., 2018; Strang et al., 2018). Because of the lack of a control group, it is not possible to compare the outcome of FP among the transgirls to that in cis-gender adolescent males. In adults, poorer semen parameters and a higher incidence of oligozoospermia have been observed in transwomen compared with cisgender controls (Hamada et al., 2015; Li, Rodriguez, Gabrielsen, Centola, & Tanrikut, 2018). The cause of this difference is unclear, but psychological stress, self-induced high scrotal position of the testes, the use of tight underwear, and undisclosed hormone use were suggested as possible explanations as well as genetic causes (Hamada et al., 2015). Some of the adolescents in the present study also ‘tucked away’ their testes which may affect testicular function. One adolescent with severe oligozoospermia had one inguinal testis, which can be associated with subfertility. Limitations of this study are its retrospective design and the small study population. Information on sexual orientation or desire to have children was not documented for all individuals. The influence of these factors could be further explored in a prospective study using standardized questionnaires or interviews about reasons for declining FP. Such a study may also shed light on the difference in rate of FP between different clinics. Future research is also needed to observe how many of the transgirls eventually will make use of the cryopreserved semen, and in case they do not, what the reasons are for not doing so. This could help to get better insight in parenthood goals among transwomen and could improve counselling of transgirls starting hormonal treatment. In addition, it is important to investigate if individuals feel regret at not having cryopreserved their semen as they grow older. In conclusion, one third of the transgirls attempted FP, and most were able to store sperm suitable for future intrauterine insemination or ICSI. This stresses the need to discuss this topic before the start of treatment with GnRHa. Making different sperm extraction options available such as testicular sperm extraction or electroejaculation stimulation may make FP more accessible for transgirls for whom masturbation is a barrier. FP is currently not available for early pubertal adolescents, but research in this area might open up FP options for this group too. With future options on the way, an ethical and legal debate is essential, taking into account the right to equality and non-discrimination and the right to procreate of transgender people.