Date of Award

January 2018

Document Type


Degree Name

Medical Doctor (MD)



First Advisor

Amanda Kallen

Second Advisor

Julia Cron


The goal of this study was to determine the knowledge and attitudes of transgender adolescents regarding fertility and future parenthood. We developed and administered a cross-sectional questionnaire to a convenience sample of 23 transgender and gender non-conforming adolescents (mean age 16.2 ± 2.6) who attended the Yale Pediatric Gender Program between October 2016 and August 2017. Our results indicate that transgender adolescents have a basic understanding of reproductive health and fertility (mean total knowledge score of 3.78 ± 0.80 out of 5). Knowledge scores were significantly higher in participants with previous information about gender-affirming hormone therapy (GAH; p<0.05), which most commonly came from a physician (65%). When asked about future parenthood, most participants favored non-biological over biological parenthood (70% vs. 22%). Similar proportions of participants viewed future parenthood as important and unimportant (both 30%), but those who reported future parenthood as the least important had the greatest level of concern about becoming a parent (p<0.0001). Other common concerns included the postponement of GAH to preserve fertility (35%) and the time and effort required to have a child (30%). Outcomes did not differ significantly by use of pubertal blockers or GAH. In conclusion, transgender adolescents at our university-based clinic are overall knowledgeable about reproductive health and fertility and favor non-biological parenthood. Patient education by providers effectively increases knowledge and awareness of transgender-specific fertility topics. Despite this, many still disclose concerns and may express these concerns as disinterest in parenthood. This data highlights the need for frequent and repeated counseling with every patient about the risks for diminished fertility with GAH and options for future parenthood. Doing so will enable transgender adolescents to make reproductive-related decisions based on careful consideration rather than fear or concern.


This thesis is restricted to Yale network users only. It will be made publicly available on 06/27/2020