For the most part, the conversations and imagery about fertility and starting a family revolve around cisgender women and couples. It can become a challenge for transgender, gender-queer, and nonbinary (TGNB) individuals who are hoping to have children to find themselves represented. On top of that, it can be difficult for them to talk to their doctor, health care provider, or a fertility specialist about their options. This means that many questions they may have about the fertility process go unanswered.
To answer the most important question: It is absolutely possible to have kids as a transgender, gender-queer, or nonbinary individual or couple.
At Arizona Center for Reproductive Endocrinology & Infertility, we want all our patients to feel comfortable coming to us with their family-planning and fertility questions. Hoping to clarify and illuminate the fertility process and procedures for TGNB individuals, here are the answers to a few more important questions.
How can or does my medical transition impact my fertility?
Fertility preservation after different types of medical transition is possible, although the extent of it after certain therapies is still unclear. This is good news, considering hormone replacement therapy (HRT) often begins in teenage years. Many young adults who identify as transgender or nonbinary are asked to make decisions about their fertility at such a young age—often before they consider whether or how to preserve their fertility before transitioning.
There currently aren’t very many studies on transgender individuals, hormones, and fertility, so some questions remain unanswered. However, from what we know, the effects of hormone therapy on fertility are reversible.
How does testosterone therapy affect fertility?
Data suggests that testosterone does not appear to damage or prevent ovary function in transmen—even if used for several years.
Because testosterone prevents ovulation, you will have to stop taking the hormone in order to resume ovulation and be able to conceive. Each person’s experience is unique, but according to a study done by the University of California, San Francisco, 80% of people will begin ovulating again within six months after they stop taking testosterone.
How does estrogen therapy affect fertility?
Unlike testosterone, transwomen who want to use their own sperm to create a baby after estrogen therapy might find it more challenging. Estrogen affects sperm production, motility, and quality, and it isn’t quite yet known if its impact is long-term. If you are considering estrogen therapy and are interested in having a child using your own sperm one day, you may want to freeze your sperm (to use for IVF, IUI, or ICI) before starting your transition.
How does gender confirmation surgery (GCS) affect fertility?
Gender confirmation surgery—also known as gender-affirming surgery (GAS), sex reassignment surgery (SRS), genital surgery, or “bottom” surgery—has the biggest potential impact on fertility, since a person’s reproductive organs are removed or changed.
With a hysterectomy, which removes the uterus, the ability to carry a pregnancy is affected—but a transman can still use their own eggs to conceive a child after the procedure. However, if an individual chooses to remove their gonads (either ovaries or testes), that removes the ability to use their gametes (eggs or sperm) in the future as well.
If GCS is part of your transition journey, you still have options. Transmen can freeze their eggs or embryos before the procedure, and transwomen have the option to freeze their sperm before undergoing the surgery. The frozen eggs, embryos, or sperm can then be thawed and used in IVF, IUI, or ICI.
Everyone deserves to feel supported and affirmed when they decide to start to become parents. We understand that deciding to pause HRT in order to conceive can lead to anxiety and gender dysphoria, but at AZCREI we want you to feel safe and supported in every way possible. Our team is here to answer any of your questions and connect you to additional support and affirmative resources to help on your new journey to parenthood. For more information or to schedule an appointment with us, visit us online or call 520-326-0001.