Assessing Barriers for Fertility Preservation Among Transgender Youth: Insurance, Costs, and State-Specific Policies

Abstract

Increasingly, children, adolescents and young adults with a diagnosis of gender dysphoria are presenting for care desiring medical interventions to align their bodies and gender identities. For patients for whom pubertal development has progressed to Tanner stage 4 or 5, interventions include treatment with testosterone for birth-assigned males and estrogen for birth-assigned females. For younger children, puberty blockers can delay unwanted physical maturation until a decision is made about either stopping blockers and progressing through their endogenous puberty or initiating gender-affirming hormone treatment. These gender-affirming treatments may compromise gonadal function leading to infertility or biological sterility. Fertility preservation (egg and sperm freezing) prior to gender-affirming hormone treatment offers youth pursuing these treatments options for future biological parenthood. This paper begins with an overview of currently available medical treatments and the costs for procedures in this unique population. Subsequently, a review of both state and federal insurance coverage policies regarding fertility preservation and other fertility care procedures is offered, focusing specifically on the case studies of Illinois, Connecticut, and Rhode Island where recent changes in state insurance codes have expanded coverage for these medical services. Finally, the paper provides an analysis and discussion of relevant qualitative interview data from the Trans Youth Fertility Study (TYFS), an ongoing project using qualitative interviews with transgender youth and parents to investigate their experiences with navigating medical insurance and costs associated with fertility preservation.

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