The media, fueled by politicians, has sent mixed messages about how gender-affirming medical care impacts fertility for #transgender youth.

Here's the real science and medicine. (1/8)

Puberty blockers unambiguously do not impair fertility. They've been used for decades for precocious puberty (a condition where kids start puberty too early). There are no data indicating they impair fertility. If these medications are stopped, endogenous puberty proceeds (2/8)

Gender-affirming hormones (estrogen & testosterone) *may* theoretically impair fertility. Many adults who start then stop these medications have had intact fertility. However, there's a theoretical risk that if you start them right after blockers, fertility may be impacted (3/8)

For this reason, existing medical guidelines for gender-affirming care for #transgender youth are conservative and recommend fertility counseling. Some youth will choose to bank sperm or eggs, but this is an invasive expensive procedure, so many do not. (4/8)

If you don't bank sperm or eggs before starting a puberty blocker, you can stop the blocker for a short time later, prior to starting estrogen or testosterone, to allow puberty to progress a bit and bank sperm or eggs. (5/8)

It's certainly tricky talking to adolescents about fertility questions. However, many have nuanced thought processes around this (e.g. "I'm a trans girl and attracted to boys only - I don't want to have two sets of sperm and would rather adopt"). (6/8)

These are nuanced conversations to be had between parents, adolescents, and doctors. Politicians should not be involved. And they certainly shouldn't be spreading inaccurate medical information about the topic. (7/8)

You can read more about the detailed science and medicine regarding fertility for #transgender youth in our textbook (chapter 15). (8/8) https://www.jackturban.com/textbook