Transgender Fertility: Understanding Options for Family Building

Transgender individuals face unique challenges when it comes to family planning and fertility preservation. While hormone therapy and gender-affirming surgeries can help individuals feel more comfortable in their own bodies, these treatments can also have a significant impact on reproductive function. As such, it is important for transgender individuals to be aware of their fertility options and to work with a healthcare provider who is knowledgeable about transgender fertility.

Hormone Therapy and Fertility

Hormone therapy is a common component of transgender healthcare. For transgender men (individuals assigned female at birth who identify as male), testosterone therapy is often used to help masculinize the body. For transgender women (individuals assigned male at birth who identify as female), estrogen therapy is used to help feminize the body. While hormone therapy can be an important aspect of gender transition, it can also have an impact on fertility.

Testosterone therapy can cause a cessation of menstrual cycles and a reduction in ovarian function in transgender men. This can make it difficult or impossible to conceive using one's own eggs. Similarly, estrogen therapy can decrease sperm production and reduce testicular function in transgender women, making it difficult to conceive using one's own sperm.

Fertility Preservation

For transgender individuals who want to have biological children in the future, fertility preservation may be an option. Fertility preservation involves freezing eggs, sperm, or embryos for use in the future. This allows transgender individuals to preserve their fertility before undergoing hormone therapy or gender-affirming surgeries that may impact reproductive function.

The best time to freeze eggs or sperm is before beginning hormone therapy. However, it is still possible to preserve fertility after starting hormone therapy, though the process may be more complicated. For example, transgender women who are on estrogen therapy may need to temporarily stop taking estrogen and undergo a sperm retrieval procedure in order to freeze sperm. Similarly, transgender men who are on testosterone therapy may need to stop taking testosterone and undergo an egg retrieval procedure in order to freeze eggs.

Fertility Options for Transgender Couples

For transgender couples, fertility options may include intrauterine insemination (IUI) or in vitro fertilization (IVF). IUI involves placing sperm directly into the uterus using a catheter, while IVF involves combining eggs and sperm in a laboratory and then transferring the resulting embryos into the uterus.

For transgender women who have undergone gender-affirming surgery to remove the testes, donor sperm may be necessary for IUI or IVF. For transgender men who have undergone gender-affirming surgery to remove the ovaries, donor eggs may be necessary for IVF.

Working with a Healthcare Provider

When it comes to transgender fertility, it is important to work with a healthcare provider who is knowledgeable and experienced in this area. This may involve finding a fertility specialist who is well-versed in working with transgender patients, or it may involve working closely with a primary care physician or endocrinologist who can help coordinate care.

Transgender individuals should feel comfortable discussing their fertility goals with their healthcare provider, and should be prepared to ask questions about their options for fertility preservation and family planning. With the right support and guidance, transgender individuals can take steps to preserve their fertility and achieve their goals for building a family.