214 Chapter 11 been to the fertility clinic to try to cryopreserve sperm. One transgirl who had been referred had not been to the fertility clinic and had not started treatment with PS yet at the time of the analysis because of psychosocial issues. Nine (75%) of the transgirls who had been to the fertility clinic to try to cryopreserve sperm, were able to cryopreserve sperm suitable for intrauterine insemination ((IUI) or intracytoplasmic sperm injection (ICSI). Given reasons for not wanting to be referred for fertility preservation were (some of the transgirls gave more than one reason) not wanting to have children (17%, n = 4), wanting to adopt (13%, n = 3), feeling uncomfortable with masturbation or having an aversion of their penis (17%, n = 4), and feeling uncomfortable with the idea of being the biological father of the child (4%, n = 1). No specific reason for declining fertility preservation was known in eight (33%) adolescents, and eight (33%) of the adolescents were not referred for fertility preservation because they were in early puberty and were not able to produce a semen sample through masturbation. The mean age at the start of treatment with PS in the group of transgirls who attempted fertility preservation was significantly higher than in the group that did not attempt fertility preservation. Tanner stage, testicular volume, and mean IQ in the group who attempted fertility preservation was not significantly different from that in the group who did not. Neither were family situation and psychiatric comorbidity (depression, anxiety disorder, posttraumatic stress disorder, or autism spectrum disorder). Furthermore, fewer Caucasian transgirls (20%) attempted fertility preservation than transgirls (70%) with other ethnicities including Asian, African, and South American. In conclusion, one third of the transgirls attempted fertility preservation, and most were able to store sperm suitable for future intrauterine insemination (IUI) or intracytoplasmic sperm injection (ICSI). This stresses the need to discuss this topic before the start of treatment with PS. Making different sperm extraction options available such as testicular sperm extraction or electroejaculation stimulation may make fertility preservation more accessible for transgirls for whom masturbation is a barrier. Fertility preservation is currently not available for early pubertal adolescents, but research in this area might open up fertility preservation 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. Chapter 9 Chapter 9 describes the evaluation of the usefulness of moral case deliberation (MCD) in dealing with moral challenges and dilemmas in the care for transgender minors. MCD is a facilitator-led, collective moral inquiry based on a real case (Dauwerse et al., 2014; Molewijk et al., 2008a; Stolper et al., 2016). It is a relatively well-established form of clinical
RkJQdWJsaXNoZXIy MjY0ODMw