More than a million Americans contemplate themselves as transgender, meaning their gender identity is different from the sex they were assigned at birth. Here we look at everything you need to know about the reproductive options for transgender individuals.
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Reproductive Options for Transgender Individuals
One of the challenges transgender people face is the issue of becoming parents for those who would like to.
Fortunately, the modern medical fraternity offers some solutions for trans men and women to be parents.
In this article, there are facts about reproductive options for transgender individuals interested in surgeries and hormonal therapy. Knowing and discussing the reproductive options for trans people is necessary in cases of well-informed consent of transitioning.
It is also a significant element of the World Professional Association for Transgender Health’s Standards of Care for the Transsexual, Transgender, and Gender Non-conforming People.
Significance of Reproductive Issues for Transgender
Research done in Belgium found that 54% of trans men wished to have children, 37.5% would have frozen their eggs if the procedure was available.
Similar research was done in Europe and found that 40% of trans women wanted to have kids, with 56% bisexual trans women and lesbians interested in using their own sperm compared to a 13% of straight trans women.
Many trans people wish to have genetically related children and 77% wished the option to freeze sperm should be regularly offered to all trans women.
Fertility conservation options may include ovarian tissue, sperm, embryo, testicular tissue cryopreservation, or oocyte. These are similar options for people undergoing Gonadotoxic cancer therapy or erectile fertility conservation for social reasons.
Assisted reproduction may incorporate the full range of fertility services. It is not yet clear whether long-term hormone exposure poses a threat to the patient or the future offspring. Trans people undergoing assisted reproduction should be aware of the lack of data on this.
Related: Adoption Options for LGBTQ+ Couples
Reproductive Options for Transgender Women
In transgender women, research shows that continued use of estrogen has been connected with testicular damage. Refurbishment of spermatogenesis due to extended estrogen treatment has not been well studied.
The most assuring option for fertility preservation for trans women is the cryopreservation of sperm before the onset of hormone therapy. Clomiphene citrate or HCG injections can also help stimulate spermatogenesis.
Recently, there have been several reported cases of uterine transplantation into non-trans women that indicate a potential later option, however, this technology is still a toddler.
Remember, in case a trans woman wishes to have genetically related children, they must bank the sperm before their testicles are removed. The World Professional Association for Transgender Health advises trans women to preserve sperm before starting hormone therapy.
Options for Trans Men
Trans men with ovaries and uteri can remain fertile after stopping androgen therapy, even after a long time of use. The anecdotal evidence supports this fact and the studies of ovary function recovery after exposure to high levels of testosterone.
However, some people may take a couple of months or years without using testosterone and assisted reproduction to get pregnant. Testosterone cannot be used during pregnancy and lactation periods as it is harmful to the fetus and can inhibit lactation.
Testosterone is not a sure way of birth control. Research shows that people with internal reproductive organs can get pregnant while still on testosterone.
Testosterone does not stop ovulation immediately and trans men with ovaries and uteri are at a high risk of getting pregnant at the beginning of hormone therapy.
Most trans people with internal reproductive organs may not notice they are pregnant since the absence of periods is normal.
In case of an unplanned pregnancy, the doctor can help in determining how far the pregnancy is and assess any risk due to the exposure of hormones on the fetus.
In case a trans man is seeking to terminate the pregnancy, the doctor will provide support and advocacy in accessing the abortion. The abortion provider may assume that the person having an abortion is a woman and would like to know how to address you, i.e. the pronoun and name.
Fertility Preservation for Children and Adolescent
Transgender children and their parents need counseling about fertility options and preservation before pubertal suppression and gender-affirming treatment.
Fertility preservation options for children who have undergone natal puberty include oocyte, embryo, sperm, and cryopreservation. Currently, it’s impossible for kids who have not undergone natal puberty to preserve sex cells.
Using gonadotropin-releasing hormone (GnRH) to suppress the onset of undesired puberty for a long time is reversible. As such, it should not affect the resumption of puberty after stopping. However, most kids who undergo pubertal repression begin gender-affirming therapy without undergoing natal puberty.
There are no changes in infertility or a high rate of birth defects in adults treated with hormone blockers. However, hormone treatment followed by sex assignment can prevent the gonads from maturing.
Kids who have undergone pubertal suppression with hormone blockers, and want to retain reproductive options before starting hormone therapy should wait until ovulation or sperm production occurs.
There are no studies about fertility preservation to determine whether sperm cells or ovaries from prepubescent children can mature while in the lab. However, there are ongoing experiments about fertility preservation on cisgender youth who are under cancer treatment.
Reproductive Options for Transgender – Final Thoughts
Most people assume that all people with testes and sperm are men and those with ovaries and uteri are women. However, this is entirely different when it comes to the transgender community.
Trans people have a completely different view of matters concerning gender that is different from the cisgender community. Regardless of the differences, trans people have the same desire to be parents just like non-trans people.
Fortunately, special medical assistance can help trans people become parents and enjoy having their own genetically related children.