Information about – Fertility
Fertility considerations for trans people
Taking hormone therapy can affect your fertility, although many trans people are able to conceive whilst temporarily stopping treatment with hormones.
While your fertility may not be a top priority for you now, it is a shame not to take steps which you may find helpful in the future.
Although you may be very keen to start hormone treatment, taking the time to store now may save regret in the future.
Please consider this carefully and let us know your options.
It is not known fully how or if hormone treatment affects people’s fertility, and everyone is different. Taking medication will mean that it is likely that your egg or sperm production will decrease and you will reduce the ability to produce eggs or sperm when needed. Hence, storing these ‘gametes’ is an important consideration for you if you wish to have biological children in the future.
If you wish the NHS or your public system to arrange this for you, then your GP will need to arrange this for you.
If you wish to store privately then just contact local fertility clinics close to you.
Storing sperm is a much easier option than storing eggs, so please do consider this carefully as it is important and a common source of regret later in life.
For more information, please see the following websites:
Testosterone – taking testosterone may affect egg production and fertility. However, many trans masculine people have stopped testosterone temporarily in order to conceive. However, testosterone cannot be considered to be a contraceptive and it could be harmful to the foetus if you got pregnant while taking it.
Oestrogen – taking oestrogen will suppress sperm production, but this may come back if you stop taking it.
Anti-androgens – these will suppress sperm production and the ability to have erections. Again, stopping these may mean that function returns.
Puberty blockers – if you are taking puberty blockers at the start of puberty, then you may not have reached the stage of being able to produce sperm or eggs to store. This has to be balanced with the masculinisation or feminisation that would occur to your body if you waited for puberty to progress far enough to allow gamete production.
Sperm Storage – Factsheet
The question of how fertility might be impacted by hormone therapy, is one which is often asked by trans women, trans youth and their parents.
It is widely accepted that gender-affirming medical and surgical treatment is likely to impair future fertility. As such it is important for trans people to consider gamete (sperm and egg) storage options. For information relating to trans masculine youth, please see our factsheet on egg preservation.
While we cannot state categorically that trans women will be rendered infertile by hormone treatment, evidence suggests that preserving sperm, in the event that biological offspring will be desired at a future point, is a step that is well worth taking.
Here we review some of the most frequently asked questions to enable anyone wanting to explore the option of sperm storage, to do so in an informed way:
What does the process of sperm storage involve?
The process for storing sperm requires the individual to attend a specialist clinic where they will be asked to produce a sperm sample. This will be frozen until such time as the sperm is required, at which stage it will be defrosted and used to inseminate either a biological female or a surrogate.
What are the key challenges for trans feminine youth in storing sperm?
Fertility preservation for trans feminine individuals is more straightforward than it is for trans masculine youth. However, there are still some challenges. The person producing the sperm must be sexually mature enough to achieve ejaculation. Waiting for this to happen while at the same time suffering with acute gender dysphoria, can create significant psychological distress. It can also be extremely distressing for a trans feminine individual to engage in a process which is so fundamentally at odds with the gender with which they identify. Often at this young age, future fertility takes a back seat to the more immediate need of assuaging the feelings brought about by dysphoria.
When will my child be sexually mature enough to reach ejaculation?
While it can be very frustrating to hear, the simple answer is: everyone is different.
There are no hard and fast rules in relation to how and when development might occur other than an age range, which can be used as a general indicator.
Is there any other way to access the sperm other than via ejaculation (which is very distressing for my child)?
Sadly, not. This is the only way that sperm can be successfully retrieved.
How long can sperm be stored for and still be viable?
In theory, sperm can be stored in this way indefinitely and will not be negatively affected based on the length of time it is frozen.
How much does it cost to store sperm?
Prices vary from clinic to clinic. It is important to budget for an initial fee followed by an ongoing storage fee, the cost of which is dependent on the amount of time the sperm is stored.
Once puberty blockers are stopped will fertility resume?
It will take a period of time (unknown) to get any blocking medication completely out of the system. Once the blocker is out of the system, male puberty will resume.
Is there any data available on the uptake of sperm storage among trans feminine youth (under 16)?
There is no data currently available on the uptake of sperm storage among trans feminine youth within this age range.
Is sperm storage available for trans youth on the NHS?
The National Institute for Clinical excellence (NICE) does not currently offer guidance for patients with gender dysphoria on the subject of sperm storage.