The desire to have children is universal, no matter if an individual is non-binary, trans or cis-gender. However, family building in the LBGTQ community usually requires more thought and planning. 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. Transwomen who have (frozen) sperm have done insemination/IVF with a female partner or used an egg donor with a gestational carrier.
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 been teaching a class 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 20 years ago, it is encouraging to see that more insurers are covering gender-affirming treatment and more clinics are offering this care.
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