Transgender fertility can be a sensitive topic. Many people don’t know where to start. However, it’s important to understand that some elements of medical transition can impact your fertility, and therefore, your ability to have children. For that reason, even if you don’t want children at this time, the question of whether to take steps to preserve your fertility is crucial to consider when you’re thinking of medical transition. 

At GenderGP, we issue our Treatment Recommendations on the basis of informed consent. This means that you don’t have to “prove” you’re trans enough to get support, advice, and access to gender-affirming care. Rather, you simply have to show that you fully understand the treatments and their short-term and long-term consequences. Fertility is one such area that requires careful consideration.

If you’d like some guidance, you can book a Fertility Referral Session to explore your options for storing your gametes (eggs or sperm). During this session, we discuss with you potential options for private (non-NHS) fertility preservation clinics that you can consult. After the session, we’re happy to provide a referral bespoke letter to the private clinic of your choosing for a small fee.

Puberty Blockers and Transgender Fertility

All medical evidence suggests that puberty blockers are fully reversible. Blockers suppress your endogenous or naturally-occurring hormones, which will reduce your fertility. If you stop taking blockers, you should experience a return of fertility within three to six months. However, this varies according to the individual.

Read more here: Latest Thinking on Fertility for Trans and Non-Binary Youth

Gender-Affirming Hormones and Transgender Fertility

Most experts consider gender-affirming hormones to be a “partially reversible” treatment. It’s possible for fertility to return if you stop taking gender-affirming hormones. However, both transmasculine and transfeminine hormone therapies can reduce fertility long term.

So, before beginning gender-affirming hormone treatment, you should consider your plans carefully and talk to your loved ones. If having biological children is important to you, talk with a medical professional about options to preserve fertility.

While in this moment it can feel like nothing is more important than starting transition, you should still take the time to ask yourself these questions, as you’ll be undergoing treatment with potentially irreversible effects.

Surgery and Transgender Fertility

Top surgeries, including chest reconstruction for transmasculine people and breast augmentation for transfeminine people, should not affect fertility.

Bottom surgeries, including salpingo-oophorectomy, hysterectomy, and phalloplasty for transmasculine people and orchidectomy and vaginoplasty for transfeminine people, will cause permanent infertility because they remove or alter the reproductive organs.

Suppose you want to have biological children later in life but plan to undergo bottom surgery. In that case, you should discuss fertility preservation options with your doctor or a relevant medical professional.

Options to Preserve Your Fertility

In fertility preservation, a small amount of reproductive material is frozen and stored for future use. For transmasculine people, this is eggs and for transfeminine people, this is sperm.

When you’re ready to have children, the material can be unfrozen. If you have preserved a sample of sperm, you can use it to fertilize an egg belonging to a donor or a partner. If you’ve preserved eggs, they can be fertilized with sperm from a donor or a partner and then implanted in your womb or that of a donor or partner.

If you are on blockers, you will need to stop taking them long enough for fertility to resume. To avoid this disruption, it might be worth thinking about fertility preservation options before you begin any treatments.

The procedures for extracting and storing reproductive material are relatively simple, but they can be expensive. For more detailed information on the procedures involved in fertility preservation and how to access them, visit the Human Fertilisation and Embryology Association.

Fertility and Young People

Young people beginning gender transition may find it particularly difficult to talk about fertility. It can be hard for them to consider things like sex and parenthood. Still, they must understand the long-term consequences of transition so that they can provide informed consent.

The important thing is to ensure that children and adolescents are supported. For instance, don’t give them an ultimatum: You have to choose between gender affirmation and fertility right now. This situation puts them under unnecessary stress.

Instead, explain that puberty blockers can give them time to think. Eventually, they will need to allow endogenous puberty to resume or start gender-affirming hormones. They should think about future fertility before this happens.

Navigating Difficult but Important Conversations

When talking to young people around adolescence, bear in mind that they are unlikely to want to talk about sex. These feelings may affect their ability to engage with the subject.

Children as young as 12 may be undergoing puberty-blocking treatment and are unlikely to have the knowledge or the emotional development to have frank conversations. Furthermore, trans adolescents going through puberty are likely to be experiencing considerable distress due to the changes happening to their bodies and trying to talk about sex could worsen this.

You can help by avoiding frank discussions of sex. Instead, try to talk to young people about having children and future plans for what their own family might look like, not sexual behavior.

Avoid unnecessary topics, and be clear and make sure they know all of their options. Our website offers access to the latest research on young people and fertility preservation.

Don’t Want to Preserve Fertility? There Are Other Options

Even if you want to have children in the future, fertility preservation might not be right for you. For some trans people, the idea of preserving reproductive material or the processes involved can be sources of gender dysphoria. Whatever the reason, it doesn’t mean you can’t have a happy, fulfilling family life.

Adoption, surrogacy, co-parenting and found family all offer ways to build the future you want without worrying about fertility issues.