20. ‘I'll Just Adopt:’ Family Building Perspectives of Trans Masculine Adolescents

Background Increasing numbers of trans masculine (TM) adolescents assigned female at birth (AFAB) adolescents are coming out earlier and seeking gender affirming care, including gender-affirming hormone therapy (GAHT). Due to a lack of information about how GAHT affects fertility, it is recommended that family building goals (specifically parenthood) be elicited from AFAB TM adolescents prior to the initiation of GAHT. Family building research in TM health usually centers around biologically (genetic and/ or pregnancy) linked goals and experiences. Little exists regarding other parenthood approaches (e.g., adoption, blended families). The objective of this study was to describe the characteristics of AFABTM adolescents who express adoption as their desired path to parenthood. Methods As part of an IRB approved retrospective cohort study regarding sexual and reproductive health in AFAB TM adolescents ages 15-17 year old being seen for initiation of testosterone GAHT between 2010- 2019, researchers identified individuals asked about family building goals. Results Of the 195 AFAB TM adolescents who were asked about family building goals 51.3% (n=100) indicated desire for adoption in their future (35.9% (70) did not endorse desiring adoption and 12.8% (25) had no desire for children). Those who desired adoption had genders which included trans man/ man (92), nonbinary (3), agender (2), and 3 additional genders. Sexual orientations included bisexual (25), straight (17), gay (14), asexual (6) and additional orientations (15). There was no difference in age at time (p=0.81) or year (p=0.31) of first visit, or race distribution (p=0.74) between those who did and did not want adoption. Zip code-based median household income also did not differ between the two groups (p=0.63). The odds of desiring adoption were no higher in those who wanted hysterectomy compared to those who did not (OR 0.66 95% CI 0.31-1.42 p=0.29), nor any lower in those where fertility preservation options were discussed (OR 1.52 95% CI 0.74-3.14, p=0.26) . Those who expressed interest in adoption were however less likely to be referred to an infertility clinician (OR 0.26 95% CI 0.09-0.77, p=0.01). Conclusions High numbers of TM adolescents are endorsing adoption as their desired parenthood pathway. Recent United States legislative changes however have further limited adoption access for TM people. Clinicians need to be sensitive to the complexities of parenthood desires of TM patients and help advocate for improved resources and decreased barriers for those desiring adoption. Further research is needed to better understand why many TM adolescents desire adoption, how this changes with age, and the barriers they face in achieving their goals.