Fertility for Transgender Persons: Know Your Options

Good to Know: 

• Transgender people have the same range of reproductive desires as do non-transgender people. 
• There are several options available to transgender persons who are interested in preserving their fertility. 
• Options for fertility preservation differ for trans men and women, but typically involves freezing either eggs, embryos, or sperm prior to hormone therapy. 

More than a million Americans consider themselves to be transgender. People who are transgender are those whose personal gender identity differs from their sex at birth, and they have the same range of reproductive desires as do non-transgender people. If you or someone you love is considering transitioning, it’s recommended that you undergo counseling as to the effects of transition on fertility as well as regarding options for fertility preservation and reproduction. 

Hormonal and surgical procedures for transgender people can have an effect on a person’s ability to reproduce. But if you’re just starting your transition, you may not be thinking about your fertility options, or you may find them too confusing to navigate. However, there are options available for preserving your fertility. Check out our article below to get a better sense of what those options are. 

What are fertility preservation options for male-to-female patients?

For trans women assigned male at birth (AMAB), you could consider freezing your sperm which can later be utilized by a female partner or gestational carrier, also known as a surrogate. The most successful option for transgender women is cryopreservation of sperm prior to initiation of hormone therapy. Clomiphene citrate or hCG injections are sometimes used to stimulate spermatogenesis, a process that ensures the production of fertilizing sperm. Though more research is still needed, there are also some reported cases of uterine transplantations in trans women that may represent a potential future option as well. 

How can a transgender women conceive? 

If you are a transgender woman with a female partner, you may choose to utilize cryopreserved sperm for partner insemination. If you do not have a female partner, you may choose to proceed with utilizing cryopreserved sperm, but with a gestational carrier instead. If you are considering this option, it usually involves obtaining eggs from a screened donor. These eggs would then be inseminated with the frozen sperm, and resulting embryos would be transferred to the gestational carrier.

What are fertility preservation options for female-to-male patients?

The effect of hormone therapy with testosterone on ovarian function is unclear. In fact, there have been reported cases of pregnancies in trans men following the discontinuation of prolonged testosterone treatment. 

As far as fertility options are concerned, transgender men assigned female at birth (AFAB) can opt to freeze either eggs or embryos—or even ovarian tissue. Freezing ovarian tissue is as of yet still an experimental procedure that should only be considered in carefully selected and counseled patients. 

How can a transgender man conceive?

Transgender men who have chosen to freeze their eggs or embryos may conceive either by gestational surrogacy, or—if they have not had a hysterectomy—they may consider carrying the pregnancy themselves. While more research is still needed, some transgender men who have initiated transition but then discontinued testosterone treatment have been able to undergo insemination of sperm or IVF with embryo transfer. 

What about children and adolescents? 

It is recommended that transgender children and adolescents—as well as their guardians—be informed and counseled regarding options for fertility preservation. If possible, this counseling should happen prior to the initiation of pubertal suppression and treatment with gender affirming hormones. 

If you or a loved one are considering transitioning, it’s important to consider your reproductive desires before beginning any type of gender-affirming care. Additionally, you should know that these assisted reproductive options are expensive and often not covered by insurance. Some trans people also find that seeking out and utilizing mental health counseling and support are useful when considering their fertility options. If have any questions or concerns about your fertility, don’t hesitate to reach out to your healthcare provider today. 

Sources 

• Reproductive Options for Transgender Individuals. (2021, September 30). Yale Medicine.
• Cheng, P. J., Pastuszak, A. W., Myers, J. B., Goodwin, I. A., & Hotaling, J. M. (2019). Fertility concerns of the transgender patient. Translational andrology and urology, 8(3), 209–218. https://doi.org/10.21037/tau.2019.05.09. 
• Gestational Surrogacy. (2019, November 1). Yale Medicine.
• Jang, T. H., Park, S. C., Yang, J. H., Kim, J. Y., Seok, J. H., Park, U. S., Choi, C. W., Lee, S. R., & Han, J. (2017). Cryopreservation and its clinical applications. Integrative medicine research, 6(1), 12–18. https://doi.org/10.1016/j.imr.2016.12.001. 
• Fertility options for transgender persons. (2016, June 17). UCSF Transgender Care.
• Hysterectomy: Purpose, Procedure, Benefits, Risks & Recovery. (n.d.). Cleveland Clinic.