Table 5.

Final learning objectives

	Priority rating: n experts who rated “yes, prioritize”/n experts who responded to the item (%)
Content Area 1: Basic Reproduction
1. To describe the body parts needed to make a baby (egg, sperm, uterus)	52/57 (91)
2. To describe the effect on the body of testosterone and estrogen in people with testicles and ovaries	49/57 (86)
3. To identify the type of gametes one’s body can make for reproduction	46/57 (81)
4. To describe basic anatomy of the human reproductive systems	45/57 (79)
5. To explain the role of puberty in reproduction (i.e., gamete production)	45/57 (79)
Content Area 2: Gender-Affirming Medical Interventions: Impacts on Fertility
6. To describe what is known or unknown about how pubertal suppression treatment impacts fertility. This includes: discussing the timing of treatment initiation, used alone or concurrent with gender-affirming hormones.	48/50 (96)
7. To describe what is known or unknown about how gender-affirming hormone treatment impacts fertility. This includes: the timing of starting treatment and previous treatment with puberty blockers.	46/50 (92)
8. To describe what is known or unknown about the reversibility of negative effects on fertility if gender-affirming hormones are stopped	46/50 (92)
9. To describe what is known or unknown about how pubertal suppression treatment impacts fertility. This includes: the time one would need to be “off” blockers in order to become fertile again.	43/50 (86)
10. To describe irreversibility of gender-affirming genital surgeries that negatively affect fertility (e.g., orchidectomy, hysterectomy, oophorectomy)	42/50 (84)
11. To describe what gender-affirming hormone treatment is (e.g., testosterone, estrogen)	41/50 (82)
12. To describe what pubertal suppression treatment is	40/50 (80)
Content Area 3: Established Fertility Preservation Options
13. To identify established fertility preservation options in the United States (oocyte, sperm, and embryo cryopreservation)	49/49 (100)
14. To explain that fertility preservation is possible even after being on testosterone or estrogen for several years	46/49 (94)
15. To summarize the process for obtaining mature gametes for cryopreservation	44/49 (90)
16. To describe when in puberty eggs or sperm can be obtained or 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)	44/49 (90)
17. To identify financial costs associated with gamete harvesting, long-term storage, and future gamete use	44/49 (90)
18. To summarize the timeline to complete gamete cryopreservation as it relates to initiation of gender-affirming medical interventions	43/49 (88)
19. To describe success rates of current cryopreservation options	41/49 (84)
20. To describe the process for using cryopreserved gametes in the future	40/49 (82)
Content Area 4: Benefits and Risks of Established Fertility Preservation Procedures
21. To identify the over-arching risks and side effects of established FP techniques, including: (1) anesthesia for oocyte retrieval surgery or surgical testicular sperm extraction; (2) inability to produce sperm or retrieve oocytes; (3) loss of cryopreserved gametes due to technical issues; (4) possibility that multiple rounds of gamete retrieval may be needed; (5) 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; (6) potential failure of saved gametes to result in a live birth in the future; (7) no long-term information on effects of gender affirming hormone on future offspring if using gametes obtained after taking gender-affirming hormones	45/53 (85)
22. To explain that fertility preservation is an individual decision with varying benefits dependent on how much one values fertility	42/53 (79)
23. To describe psychosocial implications of pursuing FP, including: (1) peace of mind and sense of relief that gametes are preserved for future use since it is difficult to predict future fertility desires during childhood/adolescence; (2) minimizes potential regret related to infertility; (3) allows for consideration of role/desires of future partners if gametes are preserved; (4) may help one’s family members to be more supportive of medical transition if fertility is preserved	41/53 (77)
Content Area 5: Alternate Pathways to Parenting
24. To identify other parenting options, including choosing not to parent, adoption, fostering, donor gametes, surrogacy	51/54 (94)
25. To recognize that desires for genetically-related children may change over time, in either direction	48/54 (89)