BACKGROUND Many transgender individuals choose to undergo gender-affirming hormone treatment (GAHT) and/or sex reassignment surgery (SRS) to alleviate the distress that is associated with gender dysphoria. Although these treatment options often succeed in alleviating such symptoms, they can also negatively impact future reproductive potential. OBJECTIVE AND RATIONALE The purpose of this systematic review was to synthesize the available psychosocial and medical literature on fertility preservation (FP) for transgender adolescents and young adults (TAYAs), to identify gaps in the current research and provide suggestions for future research directions. SEARCH METHODS A systematic review of English peer-reviewed papers published from 2001 onwards, using the preferred reporting items for systematic reviews and meta-analyses protocols (PRISMA-P) guidelines, was conducted. Four journal databases (Ovid MEDLINE, PubMed Medline, Ovid Embase and Ovid PsychINFO) were used to identify all relevant studies exploring psychosocial or medical aspects of FP in TAYAs. The search strategy used a combination of subject headings and generic terms related to the study topic and population. Bibliographies of the selected articles were also hand searched and cross-checked to ensure comprehensive coverage. All selected papers were independently reviewed by the co-authors. Characteristics of the studies, objectives and key findings were extracted, and a systematic review was conducted. OUTCOMES Included in the study were 19 psychosocial-based research papers and 21 medical-based research papers that explore fertility-related aspects specific for this population. Key psychosocial themes included the desire to have children for TAYAs; FP discussions, counselling and referrals provided by healthcare providers (HCPs); FP utilization; the attitudes, knowledge and beliefs of TAYAs, HCPs and the parents/guardians of TAYAs; and barriers to accessing FP. Key medical themes included fertility-related effects of GAHT, FP options and outcomes. From a synthesis of the literature, we conclude that there are many barriers preventing TAYAs from pursuing FP, including a lack of awareness of FP options, high costs, invasiveness of the available procedures and the potential psychological impact of the FP process. The available medical data on the reproductive effects of GAHT are diverse, and while detrimental effects are anticipated, the extent to which these effects are reversible is unknown. WIDER IMPLICATIONS FP counselling should begin as early as possible as a standard of care before GAHT to allow time for informed decisions. The current lack of high-quality medical data specific to FP counselling practice for this population means there is a reliance on expert opinion and extrapolation from studies in the cisgender population. Future research should include large-scale cohort studies (preferably multi-centered), longitudinal studies of TAYAs across the FP process, qualitative studies of the parents/guardians of TAYAs and studies evaluating the effectiveness of different strategies to improve the attitudes, knowledge and beliefs of HCPs.

中文翻译：

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变性青少年和年轻人的生育保护：系统评价。

背景技术许多跨性别个体选择接受性别确认激素治疗（GAHT）和/或性别重分配手术（SRS），以减轻与性别不安相关的痛苦。尽管这些治疗方法通常可以成功缓解此类症状，但它们也可能对未来的生殖潜力产生负面影响。目的和理由本系统综述的目的是综合有关跨性别青少年和年轻人（TAYAs）的生育力保存（FP）的可用的社会心理和医学文献，以查明当前研究的差距并为未来的研究方向提供建议。搜索方法对2001年以来发表的英语同行评审论文进行系统的回顾，使用首选报告项目进行系统评价和荟萃分析协议（PRISMA-P）指南。四个期刊数据库（Ovid MEDLINE，PubMed Medline，Ovid Embase和Ovid PsychINFO）用于识别所有相关的研究，这些研究探讨了TAYA中FP的社会心理或医学方面。搜索策略结合了主题词和与研究主题和人群相关的通用术语。所选文章的书目也经过手工搜索和交叉检查，以确保全面覆盖。所有选定的论文均由合著者独立审查。提取研究的特征，目标和主要发现，并进行系统的审查。研究结果包括19篇基于社会心理的研究论文和21篇基于医学的研究论文，探讨了该人群与生育相关的方面。主要的社会心理主题包括为TAYA育有孩子的愿望；由医疗服务提供者（HCP）提供的计划生育讨论，咨询和转诊；FP利用率；TAYA，HCP和TAYA的父母/监护人的态度，知识和信仰；以及访问FP的障碍。关键医学主题包括GAHT的生育力相关影响，FP选择和结局。从文献综述中，我们得出结论，阻碍TAYA追求计划生育存在很多障碍，包括对计划生育选项的认识不足，成本高，可利用的程序具有侵入性以及计划生育过程的潜在心理影响。关于GAHT生殖作用的可用医学数据是多种多样的，尽管预计会产生有害作用，但这些作用可逆的程度尚不清楚。对儿童的影响FP咨询应尽可能早于GAHT之前的护理标准开始，以便有时间做出明智的决定。当前缺乏针对该人群的FP咨询实践的高质量医学数据，这意味着需要依靠专家意见和来自顺产人群的研究推断。未来的研究应包括大规模队列研究（最好是多中心研究），整个FP过程中TAYA的纵向研究，TAYA父母/监护人的定性研究以及评估不同策略以改善态度，知识和信念的有效性的研究。 HCP。