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Everything You Need To Know About Transgender Fertility

A guide to having children as a trans person.

September 16, 2020
Anita Parrott

Image Courtesy of Harbor Health Clinic.

More often than not, transgender, genderqueer, and non-binary (TGNB) folks are left out of so many fertility conversations. There tends to be a focus on fertility and pregnancy when it comes to cis-gendered women, and as a result, TGNB folks can feel a bit lost when it comes to approaching having children of their own. Some aren’t aware that there are a bunch of fertility options for TGNB people because they don’t feel comfortable bringing fertility up to their doctors. 52% of TGNB people feel this way in comparison to the 18% of heterosexual cis-gendered women that do as well.  

In this article, we’ll cover:

  • Estrogen 
  • Fertility Options For Trans Women
  • Testosterone
  • Fertility Options For Trans Men
  • Finding Accessible Healthcare
  • Conclusion
A TGNB person cradles their pregnant stomach.
Many consider having children to be one of the many great wonders of the world. It’s a shared experience that’s just as inclusive as the world should be.

Estrogen

The effects of testosterone on the reproductive functions of trans women

If you’ve already used estrogen therapy it may make using your own sperm to conceive a bit more difficult. Doctors have found that estrogen can have an effect on sperm production, count, and mobility. Unfortunately, even if you stop estrogen therapies there’s a chance that your sperm will be affected. This is by no means to say that conceiving isn’t possible if a trans woman has had estrogen therapy, it’s simply a bit more complicated than fertility for trans men. 

Fertility Options For Trans Women

How to conceive as a trans woman

Before embarking on your fertility as a trans woman, you have to discontinue your hormone therapies. If you wish to conceive the available options consist of sperm cryopreservation (or usage through intrauterine insemination (IUI) of a cis female partner. Trans women could also use in vitro fertilization (IVF) using a partner or donor to conceive. There are also a series of injections such as Clomiphene Citrate that can help to restore sperm function for reproduction.

There has also been a rapid increase in the development of a precedent for uterus transplantation in trans women. This treatment isn’t ready for being an established option for conception today, but it provides a hopeful groundwork for the variety of options for trans women who want to conceive. 

Testosterone

The effects of testosterone on the reproductive functions of trans men

Unlike estrogen in trans women, 80% of people on testosterone are able to start ovulating within six months of getting off of it. There is no clear determination of any negative effects of testosterone on ovary function. While this is good news, in order to conceive, people who use testosterone therapy have to stop taking it. This causes you to start getting periods as you try to conceive. 

Getting off of T can bring up many unfavorable experiences, or feelings of gender dysmorphia which is a very important thing to consider before starting your fertility journey.

Surrounding yourself with the support you need to cope with the ways these changes are affecting your mental health can be very constructive and helpful to what you’re experiencing.  

Fertility Options For Trans Men

How to conceive as a trans man

There are a number of options for fertility treatments for trans men. Trans men can have their eggs and/or embryo frozen through cryopreservation using their partner’s sperm or a donor’s. IUI is also an option for trans men to conceive. Using IUI, you may have to use a partner or donor’s sperm. There’s also the possibility that through IVF a trans man would have to use his own, a partner’s, or a donor’s eggs in order to conceive. 

There is also a more experimental option for trans men to conceive. This involves the cryopreservation of their ovarian tissues. There is still a great deal of research that needs to go into this treatment option but it provides a promising outlook for potential routes for trans men to take in the future. 

Finding Accessible Healthcare

Searching for the care that you need in a system that’s not always kind to TGNB people

Transgender people face discrimination across many fronts all over the world, and that discrimination is unfortunately not lost in the health care system. In a 2015 survey of trans people in the United States, 23% of participants stated that they decided not to go to see a doctor when they needed to out of fear of mistreatment. Additionally, 29% of trans individuals were turned away untreated by healthcare professionals because of their perceived or real gender identity. Even further, there are many insurance providers that don’t cover hormone treatments, let alone fertility treatments for trans individuals.

That being said, the best thing you can do when trying to find reproductive specialists is your research. Try to find specialists that work with TGNB people, and know enough about your specific needs throughout your fertility journey. You can find a number of helpful reproductive resources for trans people here

A trans woman carries her daughter through a field.
It can be extremely discouraging to face discrimination in something as fundamentally necessary as healthcare. Sometimes the best you can do is try to be diligent, and surround yourself with those that love and support you. One thing that remains true about the passage of time, is that things change.

Conclusion

The path forward on your fertility journey

One of the most helpful pieces of advice we’ve found when dealing with your fertility journey is not to give up. No one’s path towards conceiving is exactly the same. We all follow paths with winds and zigzags that are unique to us. Plus, the development of new technologies and therapies are just on the horizon! With that in mind, you will reach the end of your fertility journey. It may not be in the way that you expected it to, but the feeling of seeing your child’s face for the first time can make all the difference.


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