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ABSTRACT Sexual and reproductive issues are essential elements of well-being in cisgenders as well as for the transgender population. Gender-affirming hormonal treatments (GAHTs) aim to

induce phenotypical changes congruent with the desired gender and subsequent reduction of gender dysphoria. While genital surgical procedures including hysterectomy and/or adenectomy cause

permanent loss of ability to conceive, GAHT may induce a varying degree of reversible loss of fertility. For these reasons, transgender men and women need to be counseled concerning

contraceptive options and potential effects of treatment on reproductive function before initiating GAHT. The literature reports that sexual activity with genital involvement is performed by

less than half of transgender persons who have been sexually active with a partner in the past. Testosterone (T) is the most commonly used compound in transmen and usually leads to

amenorrhea within 1–12 months from first administration, however cessation of menses does not mean anovulation. Some studies report cases of unintended pregnancies among transgender men

under masculinizing therapy, therefore T treatment cannot be considered a contraceptive option. Currently available contraceptive options have pros and cons in transmen and scarce literature

exists on their use. The effects of GAHT on fertility in transwomen are even less well known. Prolonged estrogen exposure induces sperm suppression and morphological changes of the

spermatozoa, however the degree of resulting pregnancy protection is unclear. Further research to inform the contraceptive counseling in this population is mandatory. Access through your

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BEING VIEWED BY OTHERS CURRENT USE OF TESTOSTERONE THERAPY IN LGBTQ POPULATIONS Article 23 November 2021 SEXUAL FUNCTION OF TRANSGENDER ASSIGNED FEMALE AT BIRTH SEEKING GENDER AFFIRMING

CARE: A NARRATIVE REVIEW Article 05 May 2023 INDIVIDUALIZED AND INNOVATIVE GENDER HEALTHCARE FOR TRANSGENDER AND NONBINARY YOUTH Article 07 May 2025 REFERENCES * American Psychiatric

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The authors would like to thank Julie Norbury for English copy editing. AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Gynecology and Physiopathology of Human Reproduction, S. Orsola-Malpighi

Hospital, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy Ilaria Mancini, Stefania Alvisi, 

Giulia Gava, Renato Seracchioli & Maria Cristina Meriggiola Authors * Ilaria Mancini View author publications You can also search for this author inPubMed Google Scholar * Stefania

Alvisi View author publications You can also search for this author inPubMed Google Scholar * Giulia Gava View author publications You can also search for this author inPubMed Google Scholar

* Renato Seracchioli View author publications You can also search for this author inPubMed Google Scholar * Maria Cristina Meriggiola View author publications You can also search for this

author inPubMed Google Scholar CORRESPONDING AUTHOR Correspondence to Ilaria Mancini. ETHICS DECLARATIONS CONFLICT OF INTEREST The authors declare no competing interests. ADDITIONAL

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permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Mancini, I., Alvisi, S., Gava, G. _et al._ Contraception across transgender. _Int J Impot Res_ 33, 710–719 (2021).

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