What you’ll learn
- How gender-affirming therapies can impact future reproduction
- The fertility preservation options for trans men and women
- How to understand and advocate for Trans equality
The desire to have children is universal, no matter if an individual is non-binary, trans or cis-gender. However, family building in the LGBTQ community usually requires more thought and planning. For many young transgender people who wish to have biological children later in life, they have to consider preservation very early on in their life. And gender-affirming therapies can impact future reproduction, so it is important to know about options before starting treatment.
I was one of the first physicians in the US to freeze eggs, starting in 1999. Initially, this was offered under an experimental protocol to cancer patients who were going to receive chemotherapy. Soon after, this became an option for transmen before having their uterus and ovaries removed or before starting testosterone. In the early years, most of the patients were in their 20’s and 30’s. However, as patients are starting treatment at younger ages, I have been seeing more adolescents who want to freeze their eggs.
There are many ways to have a family and freezing eggs can give patients more options in the future. Some transmen have had their partner carry the pregnancy. Some have stopped testosterone and carried the pregnancy themselves if they had a uterus. Others have opted to get a gestational carrier. Typically, fertility preservation options for transgender men include oocyte cryopreservation, embryo cryopreservation, and (less commonly) ovarian tissue cryopreservation.
Transwomen who have frozen sperm before treatment have done insemination/IVF with a female partner or used an egg donor with a gestational carrier. Research shows the most successful option for fertility preservation for transgender women is cryopreservation of sperm prior to initiation of hormone therapy. However, some transwomen may still produce sperm after starting estrogen.
Fertility preservation options for transgender persons:
- For bodies with ovaries: Egg freezing for fertility preservation is an option. This process is possible whether they have taken testosterone or not. However, they will have to stop their hormone regimen to go through this process.
- For bodies that make sperm: If their sperm quality is adequate, they can have the option to freeze and store sperm. Specimens may be used in the future with either thought IUI and IVF. The most successful option for fertility preservation for transgender women is cryopreservation of sperm prior to initiation of hormone therapy.
How to conceive as a transman or transwoman:
- For bodies with a uterus: If they haven’t undergone a hysterectomy, they can consider carrying the pregnancy themselves. Otherwise, if they have frozen eggs or embryos, using a gestational carrier is an option.
- For bodies that make sperm: Transgender women with a female partner may choose to utilize cryopreserved sperm for insemination. For transgender women who do not have female partner, they can utilize a gestational carrier with embryos created with their sperm
With the increasing use of hormone therapy and gender confirmation surgery, it is becoming even more important to provide education to physicians on healthcare concerns for transgender patients. Hoping to improve counseling and reduce barriers for patients, I have taught classes for medical students about fertility options for their LGBTQ patients. It is important that patients get all of the information that they need as early as possible so they can fulfill their reproductive goals. Since I started doing this over 20 years ago, it is encouraging to see that more insurers have covered gender-affirming treatment and more clinics are aware of fertility preservation options.
Learn More: A discussion of Trans issues, how to understand and advocate for Trans equality, and embrace gender identity, in all its forms. Hosted by renowned Trans educator, Trystan Reese.
