Fertility Care for Transgender Community
Wherever you fall under the transgender umbrella, there are many ways to form your family. If you have questions about your fertility treatment options, or have a question that isn’t covered here, feel free to reach out to us directly. Our care team is specifically trained in the principles of trans inclusion and ready to support your journey.
Pre-Transition: Sperm
If your body produces sperm and you plan to transition hormonally or surgically, it is considered best practice to capitalize on your existing fertility before transitioning medically. If you’re not ready to become a parent yet, fertility preservation is a great option while your body is still producing sperm. It is not currently known exactly how hormones will impact your long-term fertility prospects; the best data suggests that roughly 50% of all transgender women lose some or all of their fertility capability within just a few months of starting hormone replacement therapy (HRT). While some are able to regain their fertility later on, the chances of that happening are unknown and the process requires you to stop your HRT, which many trans community members would prefer not to do.
If you are ready to become a parent now, there are several things you can do to increase the chances of contributing to a successful pregnancy quickly. Many transgender women share that they don’t want to postpone their transition longer than necessary, so it can be helpful to take steps to expedite the pregnancy process if possible. One thing to note is that there is some evidence that transgender women may have lower fertility levels (including lower sperm volume, count, mobility, motility, and morphology) even before transitioning medically. So there’s a chance that you might need a bit of medical assistance to contribute to a pregnancy.
What can you do?
Sign up for a sperm analysis, which only requires one in-office visit. This will give you a crystal-clear look at your fertility capability right now, so you don’t have to postpone your transition any longer than necessary.
Pre-Transition: Eggs
If your body has eggs and you plan to transition hormonally or surgically, you have a few options available to you. You may choose to go through an egg harvesting process, which is especially important if your age is a concern to you. You can freeze your eggs now and use them for in vitro fertilization (IVF) at a later date, either for your own pregnancy or a pregnancy that may be carried by a partner or surrogate.
Hormones and Fertility
Estrogen-based hormones and androgen blockers have a negative effect on every aspect of fertility for transgender women. In some cases, the effects are reversible and enough fertility can be regained if HRT is stopped for a period of time. Our providers are able to support you through this process, doing regular semen analyses to reduce the amount of time you have to be off of HRT. In some cases, additional prescription medications can assist with sperm production; our providers can walk you through the options that are most likely to lead to increased fertility levels for your unique case.
Testosterone, however, is believed to have temporary (reversible) impacts on fertility. Specifically, testosterone does impact ovulation (the process through which your body matures eggs and gets them ready for fertilization) while you’re taking it. However, many studies show that ovulation usually returns after only a few months spent off of testosterone. Our providers can work with you to manage the effects of stopping your testosterone regimen and tracking your fertility closely to minimize your time off of hormones.
Surgery and Fertility
Some transgender women undergo vasectomies as part of their medical transition. For cisgender men, a reversal commonly results in a 30%-90% pregnancy success rate. However, if you’ve been taking HRT, your fertility may or may not return following a reversal procedure.
