The impact of tucking on fertility among transgender women: A systematic review.

INTRODUCTION

Tucking involves maneuvering the testicles into the inguinal canal and compressing one's penis and scrotum posteriorly for a smoother pelvic area. A study based in Baltimore reports that 74.7% of transgender women engage in this practice.

OBJECTIVES

Fertility preservation is a significant concern for many transgender women, however, the implications of tucking on fertility remain underexplored. This review aims to bridge this knowledge gap.

METHODS

Using PRIMSA guidelines, a systematic search across various databases was conducted to identify studies evaluating the impact of genital tucking on fertility. Keywords related to tucking, transgender identity, and fertility were utilized.

RESULTS

In total, 127 manuscripts were identified, of which 11 satisfied the inclusion and exclusion criteria. Four studies noted significant differences in semen parameters between cisgender men and transgender women prior to gender-affirming hormone therapy suggesting tucking as a potential factor. Two studies documented tucking prior to semen analysis but did not establish a definitive link between tucking and lower semen parameters in transgender women. One study, with a larger sample size of 113 transgender women, discovered an odds ratio of 7.95 between extensive tucking and low total motile sperm count. One year-long study on daily tucking reported a decline of up to 98% in total motile sperm count, and a complementary paper noted an increase in abnormal sperm morphology. Two case reports observed that after a 3-4 month cessation from tucking, semen parameters returned to normal.

CONCLUSION

The review highlights the prevalence of tucking among transgender women and the negative impact on fertility it may have. Temporary cessation of tucking may improve semen parameters for fertility preservation. A harm reduction approach should be implemented to balance fertility aspirations with the management of gender dysphoria.