Original Article| Volume 36, ISSUE 1, P25-32, February 2023

Retrospective Review of Sexual and Reproductive Health Conversations During Initial Visits of Adolescents Seeking Gender-Affirming Testosterone

  • Garrett Garborcauskas
    Address correspondence to: Garrett Garborcauskas, 300 Longwood Avenue Boston, MA 02115
    Frank H Netter School of Medicine at Quinnipiac University, North Haven, Connecticut
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  • Elizabeth R. Boskey
    Center for Gender Surgery, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts

    Department of Surgery, Harvard Medical School, Boston, Massachusetts
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  • Carly E. Guss
    Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts

    Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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  • Frances W. Grimstad
    Center for Gender Surgery, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts

    Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts

    Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
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Published:September 23, 2022DOI:


      Study Objective

      To use a retrospective review of sexual and reproductive health (SRH) counseling that occurred during initial visits of adolescents seeking testosterone gender-affirming hormone therapy to determine the feasibility of using such visits to manage SRH


      Retrospective chart review


      Children's hospital, multidisciplinary gender clinic


      Transgender male and nonbinary patients assigned female at birth (TGD-M) aged 15-17 seen for initiation of testosterone between January 1, 2010, and December 31, 2019


      Not applicable

      Main outcome measure(s)

      Counseling on (1) testosterone impact on fertility and (2) fertility preservation; assessment of (3) desire for gender-affirming surgery, (4) sexual activity, (5) sexual orientation, and (6) human papilloma virus vaccination as documented during the initial visit.


      Of 195 patients who met the inclusion criteria, only 3 (1.5%) had all 6 measures addressed. The median number addressed was 4 out of 6 (IQR = 2-5/6), with fertility counseling (95.9%, n = 187) being most common, followed by assessment of surgery desire (74.4%, n = 145), sexual orientation (69.2%, n = 135), and sexual activity (69.2%, n = 135). The odds of being asked about sexual orientation were 5.3 times higher in patients who endorsed sexual activity than in those who did not (P < .001; 95% CI, 9.8-10.3).


      Providers of adolescent gender-affirming hormone therapy regularly assess and counsel on certain aspects of SRH as part of their initial visits for those seeking testosterone. Our data suggest that these initial visits for patients seeking testosterone represent an opportunity to expand SRH assessment and counseling among TGD-M adolescents.

      Key Words

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