A lot of fertility information is geared towards heterosexual couples, so it can be challenging for people outside the gender binary to find resources geared specifically to their fertility journey. That doesn’t mean there aren’t plenty of fertility options for transgender, non-conforming, and non-binary people! Here’s a rundown on the options available, along with information on how transitional therapies, whether medical or surgical, can impact fertility. All the information below comes from a webinar with our very own Dr. Darcy Broughton, which you can find Here
Impact of Hormone Treatment on Transgender Fertility
For a long time, it was assumed the hormone therapy used in medical transitioning negatively impacts fertility. While there is still not enough conclusive research, recent studies have shown some promising results for trans men in particular.
A 2020 study showed that transgender men using testosterone therapy had similar success with egg retrieval as cisgender women, after stopping testosterone for an average of 4 months before beginning the egg retrieval treatment process. This suggests that the ovulation-suppressing effects of testosterone therapy may be reversible for fertility preservation without seriously impacting the quality or quantity of eggs.
For individuals using estrogen therapy, the information is a little less clear. The current available data suggests that the effects of estrogen on sperm production may not be reversible, so attempting fertility preservation (such as sperm freezing) after starting estrogen therapy might not be successful.
One of the biggest questions for which, unfortunately, there is extremely little data, is whether using puberty blockers has long lasting effects on fertility for transgender people. The short answer is: we just don’t know yet. Hopefully, there will be more research in the coming years to answer this extremely important question.
Impact of Gender-Affirming Surgery on Fertility
Surgical transitions affect fertility in different ways, depending on the type of surgery involved. Top surgeries have no effect on reproductive abilities, although they may impact an individual’s ability to chestfeed. A hysterectomy (removing the uterus) would only impact the individual’s ability to carry a pregnancy, but they could still produce viable eggs for future pregnancies. On the other hand, a gonadectomy (removing the gametes, either sperm or eggs) removes the ability to produce or retrieve gametes after the surgery. In that case, fertility preservation can be an important option before the gender affirming surgery.
Fertility Preservation Options
Because medical and surgical transitions can impact fertility, it’s important to know the options available in fertility preservation for transgender/gender non-conforming/nonbinary people, ideally before starting any transition treatments.
Individuals with Testes
⁃You can freeze your semen (sperm cryopreservation)
⁃If you’re planning to get a gonadectomy to remove your testicles, the doctor can remove and preserve sperm at the same time.
Individuals with Ovaries
⁃You can freeze your eggs (oocyte cryopreservation)
⁃Ideally, this happens before starting any testosterone therapy, but there have been positive results for trans men retrieving eggs after a temporary pause in T therapy.
⁃Unfortunately, it’s not currently possible to retrieve eggs during surgery to remove the ovaries, because of the way the eggs develop over time.
For all TGNB people
⁃If you have a source for the opposite gamete (partner or donor), we can create embryos (fertilized eggs) and freeze those as well – a viable sperm and egg are required
Third Party Reproductive Options for TGNB family building
If you and/or your partner are not able to or interested in providing both gametes (sperm or eggs) or carrying the pregnancy, there are plenty of ways to use donor gametes or a gestational carrier to create a baby. sperm, egg, and even embryo donation are all available options, whether from known donors or through an agency. Similarly, a gestational carrier who can carry the pregnancy (sometimes called a “surrogate”) can be someone you know or found through an agency.
Pregnancy in Transgender Men
We know this is getting old, but: there’s still not a lot of data! However, in addition to the positive results for egg retrieval after stopping testosterone therapy, there have been several instances of transmasculine people successfully carrying and delivering happy, healthy children. Getting pregnant does require stopping testosterone and having periods again, as well as other physical changes that may be triggering, so it’s very important to consider the possible dysphoric effects when deciding whether you want to carry a pregnancy.
Your Fertility Journey is Your Decision
We know that the variety of fertility options can be overwhelming, but for our transgender, gender non-conforming, and non-binary patients, these options often provide the freedom of choice. Ultimately, every decision is up to you, based on your goals for family building, your relationship to your body and self, and the support systems around you. One of the most important steps you can take is to find a fertility provider who understands and supports your specific needs in an inclusive and knowledgeable environment. In future articles, we’ll share some success strategies for navigating your personal fertility journey.