Sperm Quality in Transfeminine People: Key Research Before Fertility-Preservation

Transgender women considering fertility preservation before gender-affirming hormone therapy are often advised to bank sperm. That advice is sound. But a growing body of research reveals something important: many transgender women already have lower sperm quality before they ever start hormone therapy.

This is not a reason to give up on fertility preservation. It is a reason to understand the data and to act early. Here is what the latest 2026 research shows.

Sperm Quality Is Often Already Impaired Before Hormone Therapy

A 2026 study published in Andrology found that among treatment-naïve transgender women, those who had not yet started hormone therapy, only 46.9 % met WHO criteria for normal semen parameters, compared with 75.5 % of cisgender male controls.

A July 2026 meta-analysis published in Human Reproduction, which pooled data from 14 studies including 1 028 transgender women, reached a broader conclusion. Even without prior hormone exposure, transgender women had significantly poorer semen quality versus cisgender male reference groups.

In other words, impaired sperm quality is not an effect created by hormone therapy. It frequently already exists prior to starting GAHT.

What May Contribute to Lower Sperm Quality?

Two main contributing factors have been identified in recent research.

1. Tucking 

Tucking describes the practice of repositioning testes into the inguinal canal while compressing the penis and scrotum to create a flatter external profile. One Baltimore-based study estimated that 74.7 % of transgender women engage in tucking.

Tucking holds testicles at elevated temperature for prolonged periods. Healthy spermatogenesis requires testicular temperature 1-2°C cooler than core body temperature; chronic heat exposure can damage sperm production.

A 2026 systematic review in the International Journal of Transgender Health synthesised findings across 11 relevant studies. One cohort of 113 transgender women found an odds ratio of 7.95 linking extensive tucking to low total motile sperm count.

(Note: An odds ratio demonstrates statistical association and does not translate directly to absolute personal risk.)

A oneyear observational study of daily tucking behaviour recorded up to a 98 % drop in total motile sperm alongside higher rates of morphologically abnormal sperm.

2. Baseline hormonal environment 

Even before starting exogenous gender-affirming hormones, transfeminine people may have intrinsic hormonal profiles different from cisgender men.

Critical caveat: Most of these published results come from observational studies, which show associations rather than proven cause-and-effect links.

While the tucking-semen-quality signal is repeatedly replicated across multiple papers, individual biological variation remains substantial.

Is Sperm Banking Still Worthwhile If Sperm Quality Is Low?

This is the most important practical question, and the short answer is yes.

The same 2026 meta-analysis documenting baseline semen deficits also reported a reassuring finding: over 90 % of ejaculated samples were still suitable for cryopreservation and future use with intracytoplasmic sperm injection (ICSI).

ICSI only requires a very small number of viable, normally formed sperm for fertilisation. Even if standard semen analysis returns sub-optimal results, laboratories can usually isolate usable sperm for freezing.

For severely compromised semen parameters, testicular sperm extraction (TESE), surgical retrieval directly from testicular tissue, is an alternative option.

Lower-than-expected sperm quality does not mean fertility preservation is impossible. It highlights the value of acting early and working with your reproductive provider to select the best preservation strategy for you.

Should You Adjust Tucking Habits Before Sperm Freezing?

The 2026 systematic review notes that temporary cessation of tucking may improve semen parameters. A finding from the 2026 NHS observational cohort found that co-occurrence of gender-affirming hormone therapy plus tucking was associated with significantly reduced maximum total motile sperm count. 

Two published case reports described semen parameters returning to normal ranges 3-4 months after stopping tucking.

This suggests tucking's negative impact on semen may be amplified once hormone therapy has commenced.

If you are planning sperm cryopreservation, discuss with your provider whether and for how long to pause tucking. Recommendations should be tailored to your tucking frequency, baseline semen test results, and personal circumstances.

Note: Observations are drawn from isolated case reports, not large-scale clinical trials.

The Bottom Line

People who are transgender / transfeminine exploring fertility preservation may face sobering baseline test results: sperm quality can already be sub-optimal before starting GAHT. Even so, 90 % of samples are still viable for cryopreservation and ICSI.

Early action is key. Whether you have begun hormone therapy or not, consult a reproductive-health specialist promptly to test your semen status and build your fertility-preservation plan.

Have questions about sperm freezing and fertility preservation for transgender and gender-diverse patients? Connect with the CEF fertility team. Email info@cefivf.com or visit our Contact page.

Disclaimer: This educational article summarises peer-reviewed observational studies published in 2026 across Andrology and Human Reproduction. Many findings reflect statistical associations rather than proven causation; some evidence is derived from individual case reports.

It is not personalised medical advice. Please work with a culturally-competent licensed reproductive-medicine specialist for your individual care decisions.