Table 4.
Revised learning objectives based on Round 1 expert feedback
| Learning objective | Importance rating: n experts who rated item as “very important” or “extremely important”/n experts who responded to the item (%) |
|---|---|
| Content Area 1: Basic Reproduction | |
| 1. To describe the effect on the body of testosterone and estrogen in people with testicles and ovaries | 55/59 (93) |
| 2. To identify the type of gametes one’s body can make for reproduction | 53/59 (90) |
| 3. To describe the body parts needed to make a baby (egg, sperm, uterus) | 52/59 (88) |
| 4. To explain the role of puberty in reproduction (i.e., gamete production) | 47/59 (80) |
| 5. To describe basic anatomy of the human reproductive systems | 47/59 (80) |
| 6. To introduce the idea that no one knows their future fertility potential, cisgender or transgender | 46/59 (78) |
| 7. To identify the stage of puberty when mature gametes are typically made | 40/59 (68) |
| 8. To compare conceiving a baby to carrying a pregnancy | 40/59 (68) |
| 9. To explain that oral and anal sex do not result in pregnancy | 29/59 (49) |
| Content Area 2: Gender-Affirming Medical Interventions: Impacts on Fertility | |
| 10. To describe what pubertal suppression treatment is | 58/58 (100) |
| 11. To describe what gender-affirming hormone treatment is (e.g., testosterone/estrogen) | 56/58 (97) |
| 12. To describe what is known/unknown about reversibility of negative effects on fertility if gender-affirming hormones are stopped | 56/58 (97) |
| 13. To describe what is known/unknown about how pubertal suppression treatment impacts fertility. This includes: discussing the timing of treatment initiation, used alone or concurrent with gender-affirming hormones | 54/57 (95) |
| 14. To describe the potential to reverse the effects of pubertal suppression treatment on fertility. For example, the time one would need to be “off” blockers in order to become fertile again. | 54/57 (95) |
| 15. To describe what is known/unknown about how gender-affirming hormone treatment impacts fertility. This includes: the timing of starting treatment and previous treatment with puberty blockers | 53/57 (93) |
| 16. To describe irreversibility of gender-affirming genital surgeries that negatively affect fertility (e.g., orchidectomy; hysterectomy; oophorectomy) | 52/57 (91) |
| 17. To identify which gender-affirming genital surgeries negatively affect fertility | 52/58 (90) |
| 18. To describe how gender-affirming hormone treatment works | 50/57 (88) |
| 19. To explain that gender-affirming hormones will not allow an individual to make gametes from reproductive organs they do not have | 51/58 (88) |
| 20. To describe the availability of other gender-affirming medical treatments that have differential effects on fertility (e.g., menstrual suppression using oral contraceptives, spironolactone) | 51/58 (88) |
| 21. To explain that the effects of testosterone/estrogen treatment on future children is unknown | 49/58 (85) |
| 22. To describe how pubertal suppression works | 41/57 (72) |
| 23. To identify types of gender-affirming genital surgery | 39/58 (67) |
| Content Area 3: Established Fertility Preservation Options | |
| 24. To identify established fertility preservation options in the United States (oocyte, sperm, and embryo cryopreservation) | 56/56 (100) |
| 25. To identify financial costs associated with gamete harvesting, long-term storage, and future gamete use | 54/56 (96) |
| 26. To explain that fertility preservation is possible even after being on testosterone/estrogen for several years | 53/56 (95) |
| 27. To describe when in puberty eggs/sperm can be obtained/frozen using non-experimental methods (e.g., after menses in someone assigned female at birth; after testes are about 12–15 ml in someone assigned male at birth) | 51/56 (91) |
| 28. To identify which financial costs may or may not be covered by insurance | 51/56 (91) |
| 29. To summarize the process for obtaining mature gametes for cryopreservation | 49/56 (88) |
| 30. To summarize the timeline to complete gamete cryopreservation as it relates to initiation of gender-affirming medical interventions | 47/56 (84) |
| 31. To describe success rates of current cryopreservation options | 44/55 (80) |
| 32. To recognize the possibility of multiple cycles of oocyte harvesting/sperm banking to have a reasonable chance of success with future use | 44/56 (79) |
| 33. To describe the process for using cryopreserved gametes in the future | 44/56 (79) |
| 34. To recognize the possibility of using sperm or egg donation from a relative (e.g., sibling) | 43/56 (77) |
| 35. To describe the lived experience of transgender individuals who have chosen to seek fertility preservation | 41/55 (75) |
| 36. To describe potential barriers in using cryopreserved gametes including ability to use gestational carrier (varies by U.S. state) | 35/56 (63) |
| 37. To describe the limited research on viability of using gametes that have been frozen for 10+ years | 33/55 (60) |
| 38. To describe what happens to frozen gametes that are not used | 20/56 (36) |
| Content Area 4: Benefits and Risks of Established Fertility Preservation Procedures | |
| 39. To identify the over-arching risks/side effects of established fertility preservation techniques, including: Possibility of permanent physical changes should one opt to stop pubertal suppression or gender-affirming hormone treatment for a period of time to complete fertility preservation | 52/55 (95) |
| 40. To explain that fertility preservation is an individual decision with varying benefits dependent on how much one values fertility | 49/54 (91) |
| 41. To identify the over-arching risks/side effects of established fertility preservation techniques, including: Possibility that multiple rounds of gamete retrieval may be needed | 45/54 (83) |
| 42. To identify the over-arching risks/side effects of established fertility preservation techniques, including: Potential failure of saved gametes to result in a live birth in the future | 45/55 (82) |
| 43. To identify the over-arching risks/side effects of established fertility preservation techniques, including: Inability to produce sperm or retrieve oocytes | 44/55 (80) |
| 44. To identify risks/side effects of oocyte cryopreservation including: Side effects of hormonal stimulation like breast tenderness and menses can worsen gender dysphoria | 43/55 (78) |
| 45. To identify the over-arching risks/side effects of established fertility preservation techniques, including: No long-term information on effects of gender-affirming hormone on future offspring if using gametes obtained after taking gender affirming hormones | 41/55 (75) |
| 46. To identify risks/side effects of sperm cryopreservation, including masturbation or ejaculation can worsen gender dysphoria | 41/55 (75) |
| 47. To describe psychological implications of pursuing fertility preservation, including: Allows for consideration of role/desires of future partners if gametes are preserved | 39/54 (72) |
| 48. To identify the over-arching risks/side effects of established fertility preservation techniques, including: Anesthesia for oocyte retrieval surgery or surgical testicular sperm extraction | 39/55 (71) |
| 49. To describe psychological implications of pursuing fertility preservation, including: Minimizes potential regret related to infertility | 39/55 (71) |
| 50. To describe psychological implications of pursuing fertility preservation, including: Peace of mind/sense of relief that gametes are preserved for future use since it is difficult to predict future fertility desires during childhood/adolescence | 38/55 (69) |
| 51. To identify risks/side effects of oocyte cryopreservation including: Ovarian hyper-stimulation syndrome | 31/55 (56) |
| 52. To identify the over-arching risks/side effects of established fertility preservation techniques, including: Loss of cryopreserved gametes due to technical issues | 28/55 (51) |
| 53. To describe psychological implications of pursuing fertility preservation, including: May help one’s family members to be more supportive of medical transition if fertility is preserved | 23/54 (43) |
| 54. To identify risks/side effects of oocyte cryopreservation including: Infection | 23/55 (42) |
| 55. To identify risks/side effects of oocyte cryopreservation including: Injury to bowel or bladder | 22/55 (40) |
| Content Area 5: Alternate Pathways to Parenting | |
| 56. To identify other parenting options, including choosing not to parent, adoption, fostering, donor gametes, surrogacy | 52/55 (95) |
| 57. To recognize that desires for genetically-related children may change over time, in either direction | 48/55 (87) |
| 58. To describe the lived experience of transgender and gender-expansive individuals who have chosen to pursue adoption or other family building options | 38/53 (72) |
| 59. To describe potential barriers to adoption or fostering as a transgender or gender-expansive individual depending on location/agency | 35/54 (65) |
| 60. To describe financial costs associated with adoption and variable nature of financial costs based on location/agency | 34/55 (62) |
| 61. To describe the process for adoption, including challenging parts of the process | 32/55 (58) |
Note. Learning objectives that met 75% consensus are listed in bold