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Abstract Study question Is hormone therapy impacting fertility preservation (FP) and desire of parenthood in transgender adolescents and young adult men? Summary answer Androgen therapy (AT) does not impact FP yield. Most of them had a desire of parenthood but did not whish to carry a pregnancy. What is known already In trans men, masculinization is achieved through AT (testosterone). The timing of treatment initiation relative to puberty plays a crucial role in the progression of body virilization. Testosterone induces only partial suppression of gonadotropins, allowing ovarian folliculogenesis to persist. However, limited data are available on folliculogenesis quality, oocyte competence, and the side effects of hormone therapy depending on the age at treatment initiation. Regarding parenthood, the majority of transgender individuals plan to start a family. However, literature data suggest a difference in parenthood choices with transgender men being less inclined to become parents after treatment. Study design, size, duration A monocentric, prospective, non-interventional cohort study conducted from March 2018 and November 2023 in France. Participants/materials, setting, methods A total of 98 Female to Man (FtM) patients were included. Qualitative analysis was conducted in our fertility center prior to FP to assess the individuals' desire for parenthood. For FP, we analysed the number of oocytes vitrified as well as the time period of treatment for those who initiated AT before FP. Non-parametric Mann-Whitney tests and Chi-square tests were used to compare quantitative parameters and frequencies respectively. Main results and the role of chance Among the 98 FtM patients included, the average age at the first consultation was 17.3 years. Regarding parenthood, 55% of patients expressed a desire to have children, 15% did not, and 30% were undecided. Only 16% of FtM individuals wished to carry a pregnancy. One patient consulted to discuss their parenthood project with a cisgender partner, while two patients who attended the consultation as a couple inquired about sperm donation. Regarding FP (n = 18), trans men were 17.7 (17.1-19.9) years at the time of ovarian puncture. Those under treatment (group 1, n = 6) were 18.0 (17.1-19.2) years while those who did not receive testosterone (group 2, n = 12) were 17.7 (17.1-20.2, ns) years at the time of FP. AMH level were 4.7 (3.2-5.2) and 4.7 (2.5-7.0, ns) in group 1 and group 2 respectively. The average number of oocytes vitrified was 10.0 (8.0-19.0) and 10.0 (6.8-19.8) in group 1 and group 2 respectively (ns) Limitations, reasons for caution These are preliminary results as other FP cycles are currently planned. This is a monocentric study and further studies on larger cohort are required to state on the management of FP in trans men. Wider implications of the findings Trans men may experience dysphoria if they discontinue AT, or they could lose ovarian function if they undergo gender-affirming surgery, which could impact their fertility when pursuing parenthood. If the data collected after 2023 confirm our findings, FP could be safely considered after the initiation of AT in young transmen. Trial registration number No