Fertility FAQ for Transgendered Men and Women
For transgender men and women, achieving a family can be challenging. It’s important to consider the long-term implications of hormone therapy and transition surgery as both can impact your ability to have genetically related children in the future. Dr. Samuel Pang, a reproductive endocrinologist at Boston IVF, has been treating gay and transgender men and women since 1998. Here, he discusses options for preserving your fertility and building your family before and after transitioning.
Options for Having Genetic Children
So, what if you are going to transition, what are my options to have genetic children in the future? According to Pang, have a conversation with your physician and say you’d like to freeze your eggs or freeze your sperm before you undergo any type of treatment—surgery or hormonal—that may render you incapable of producing sperm or eggs in the future.
A Transgender Woman who has banked sperm can use the sperm for intrauterine insemination (IUI) if she is in a relationship with a woman. If she is in a relationship with a man or is single, she can use an egg donor and a gestational carrier and fertilize eggs with her sperm allowing for a gestational carrier to carry the pregnancy.
A Transgender Man who has previously frozen his eggs and who is in a relationship with a woman can undergo reciprocal IVF, whereby his partner can carry an embryo created by donor sperm and his frozen eggs. If a Transgender Man is in a relationship with a man, he could use his partner’s sperm for IUI, or a gestational carrier if he does not wish to carry the pregnancy himself or is unable to carry a pregnancy.
What if you have already started my transition with hormone therapy but did not freeze your sperm or eggs prior?
Unfortunately, not all doctors present options for fertility preservation before you transition. If hormone therapy is halted, there is a possibility that sperm production may resume, and ovaries will ovulate again. What’s unknown, is how long you can be on hormone therapy before it could potentially become irreversible. “I have had transgender men who have been on testosterone therapy for up to 18 months, and when we stopped his testosterone therapy he began ovulating and menstruating, which then allowed us to stimulate his ovaries and retrieve his eggs,” Pang says. However, some Transgender men may be reluctant to stop testosterone therapy because it can be psychologically distressing; you’ve been living as a man, and now facial hair stops growing and you start menstruating. It’s an option, but it’s not ideal. That’s why it is so important to consider fertility preservation before you initiate the transition.
You might also have had or are planning to have surgery to remove your ovaries or testicles and are wondering if you still can have biological children. If the ovaries are removed you’ll no longer produce eggs, and if the testicles are removed you’ll no longer produce sperm. That’s why it’s important to preserve your fertility prior to surgery. If you’ve already had surgery, egg donation or sperm donation are both options to build your family.
Options for Children Under 18
Children are coming out and transitioning at younger ages. If you have a child under the age of 18 who is considering transitioning, there are options for preserving his or her fertility. If the child is post-pubertal, eggs or sperm can be retrieved and frozen. “The biggest obstacle would be when young boys or girls are given medications to suppress puberty,” Pang says. “A trans girl would be given drugs to prevent her from undergoing puberty so her penis and testicles won’t grow, and she won’t produce testosterone. If they don’t undergo puberty, that would present a huge challenge for fertility preservation.”
And for a child under the age of 18, there are options to preserve his or her fertility. “Most recently I had a phone call with a mother of a 14-year-old transgender son who has been considering transition[ing] from a girl to a boy for the last five years, and he was thinking about preserving his eggs before he begins hormone therapy. That is great,” Pang says. “But there are issues because he’s still a minor. We treat minors who have cancer and need fertility preservation, so we’ll use that model.”
Finding the Right Doctor
If you are looking for a transgender-friendly fertility doctor, it’s important to know that not every fertility practice is LGBTQ+ friendly, so referrals are a good place to start. And, Pang emphasizes, you don’t want a fertility practice that simply treats the LGBTQ+ community because it’s good for business, you want a practice whose entire staff is welcoming and culturally sensitive.
Dr. Jovana Lekovich is a board-certified obstetrician and gynecologist and reproductive endocrinologist and infertility specialist. She is the Director of the Oncofertility Program at Blavatnik Family- Chelsea Medical Center at Mount Sinai. Dr. Lekovich is an assistant clinical professor at the Icahn School of Medicine at Mount Sinai in New York, where she specializes in treating all aspects of reproductive medicine and infertility, including conditions such as amenorrhea, polycystic ovary syndrome, and diminished ovarian reserve with ovulation induction, intrauterine insemination, in vitro fertilization, intracytoplasmic sperm injection and preimplantation genetic testing of embryos. She also uses minimally invasive techniques such as laparoscopy and hysteroscopy to treat a variety of surgical conditions including endometriosis and uterine factor infertility.