STUDY QUESTION How do transfeminine adolescents and their parents experience fertility preservation via testicular sperm extraction (TESE)? SUMMARY ANSWER Participants experienced the TESE process positively when provided with appropriate guidance to navigate the decisional dilemma between preserving future biological parenthood and the pressure to start puberty suppression early. WHAT IS KNOWN ALREADY Sperm banking through ejaculation is not feasible for all transfeminine adolescents due to genital dysphoria and early puberty; for this group, TESE is the only alternative. However, during early puberty, they must postpone or pause puberty suppression until spermatogenesis is fully developed. STUDY DESIGN, SIZE, DURATION All consecutive TESE patients in our centre and their parents were invited to participate. Between December 2022 and May 2023, we included 6 adolescents and 10 parents. We used a qualitative approach based on semi-structured interviews to study the experience of the transfeminine adolescents and their parents. PARTICIPANTS/MATERIALS, SETTING, METHODS Transfeminine adolescents diagnosed with gender dysphoria in early puberty (Tanner stage ≥2) who underwent TESE before the start of puberty suppression or gender-affirming hormones participated in this study. The interviews were recorded, manually transcribed and analysed using reflective thematic analysis focusing on understanding the participants' experiences of puberty and fertility preservation and the various factors and social processes influencing their decision to undergo TESE. MAIN RESULTS AND THE ROLE OF CHANCE Transfeminine adolescents decide to undergo invasive fertility preservation because of a possible, future desire for parenthood. Parents stressed the importance of preventing future decisional regret. They both saw masturbation to obtain a semen sample as unreachable. Even though TESE is a surgical procedure with possible complications and pain afterwards, this alternative seemed less dysphoric to them.Adolescents had to postpone the start of puberty suppression, waiting for spermatogenesis to complete. Given the unpredictable development of puberty, they felt a lot of stress and anxiety during this period and were primarily concerned about the lowering of their voice. Because of this puberty-related stress, they were constantly balancing their motivations for fertility preservation against the early start of puberty suppression to prevent unwanted irreversible pubertal body changes. To support this decisional dilemma, adolescents and their parents need adequate communication with each other and their healthcare providers to reflect on their stress for pubertal change. Furthermore, close, continuous surveillance of their current mental state by their parents, together with their psychologist and pubertal development by their physicians, is needed. Despite the challenging decision and postponement of puberty suppression, they retrospectively experienced it positively without any regret. LIMITATIONS, REASONS FOR CAUTION All adolescents successfully underwent TESE, with viable spermatozoa obtained and without complications. This may result in a more positive reflective experience regarding fertility preservation. Furthermore, the perspectives of adolescents with the intention of TESE but who already started with puberty suppression before the preservation were not included. WIDER IMPLICATIONS OF THE FINDINGS This study helps healthcare providers improve their counselling and guidance of transfeminine adolescents who consider postponing puberty suppression for fertility preservation via TESE. The adolescents and their parents know more clearly what to expect during fertility preservation. Specific peer-support programs may facilitate the decision process for upcoming adolescents. STUDY FUNDING/COMPETING INTEREST(S) No external funding was used for this study. None of the authors have any conflicts of interest. TRIAL REGISTRATION NUMBER Not applicable.

中文翻译：

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跨性别青少年及其父母通过睾丸精子提取 （TESE） 保持生育能力的经验：一项定性研究。


研究问题：跨性别青少年及其父母如何通过睾丸精子提取 （TESE） 保持生育能力？摘要 答案 当获得适当的指导以在保留未来的亲生父母身份和提前开始青春期抑制的压力之间导航决策困境时，参与者对 TESE 过程进行了积极的体验。已知的 由于生殖器焦虑和青春期提前，通过射精建立精子库对所有跨性别青少年来说都是不可行的;对于这个群体来说，TESE 是唯一的选择。然而，在青春期早期，他们必须推迟或暂停青春期抑制，直到精子发生完全发育。研究设计、规模、持续时间 我们中心的所有连续 TESE 患者及其父母都被邀请参加。在 2022 年 12 月至 2023 年 5 月期间，我们纳入了 6 名青少年和 10 名父母。我们使用基于半结构化访谈的定性方法来研究跨性别女性青少年及其父母的经历。参与者/材料、环境、方法 在青春期早期 （Tanner 期 ≥2） 被诊断患有性别焦虑症的跨性别女性青少年在青春期抑制或性别肯定激素开始前接受了 TESE，参与了这项研究。使用反思性主题分析对访谈进行记录、手动转录和分析，重点是了解参与者的青春期和生育能力保持的经历，以及影响他们决定接受 TESE 的各种因素和社会过程。主要结果和机会的作用 跨性别女性青少年决定进行侵入性生育保留，因为未来可能希望成为父母。 家长们强调了防止未来决策后悔的重要性。他们都认为手淫以获取精液样本是遥不可及的。尽管 TESE 是一种外科手术，之后可能会出现并发症和疼痛，但这种选择对他们来说似乎不那么烦躁。青少年不得不推迟青春期抑制的开始，等待精子发生完成。鉴于青春期的发展不可预测，他们在此期间感到很大的压力和焦虑，主要担心的是声音的降低。由于这种与青春期相关的压力，他们不断平衡保持生育能力的动机与青春期抑制的早期开始，以防止不必要的不可逆的青春期身体变化。为了支持这种决策困境，青少年及其父母需要与彼此以及他们的医疗保健提供者进行充分的沟通，以反思他们对青春期变化的压力。此外，需要他们的父母和他们的心理学家对他们目前的精神状态进行密切、持续的监测，并由他们的医生对他们进行青春期发育。尽管青春期抑制的决定和推迟具有挑战性，但他们回顾性地积极地经历了它，没有任何遗憾。局限性，谨慎的原因 所有青少年都成功接受了 TESE，获得了活的精子并且没有并发症。这可能会导致对生育能力保留的更积极的反思体验。此外，未包括有意进行 TESE 但在保存前已经开始青春期抑制的青少年的观点。 研究结果的更广泛意义 本研究帮助医疗保健提供者改善对考虑通过 TESE 推迟青春期抑制以保持生育能力的跨性别女性青少年的咨询和指导。青少年和他们的父母更清楚地知道在生育能力保留期间会发生什么。特定的同伴支持计划可能有助于即将到来的青少年的决策过程。研究资金/竞争利益本研究没有使用外部资金。作者均没有任何利益冲突。试用注册号 不适用。