The challenges that transgender men face when it comes to fertility are quite unique. There is relatively little solid research out there on the fertility impact that transitioning has on transgender people. Combining that with the complications that arise in fertility in general, the landscape can be quite tricky to navigate.
Transitioning has a profound impact on the life of a transgender person. The impact that hormone replacement therapy has is not just about secondary sexual characteristics. It can cause temporary or permanent infertility in some cases and it can also lead to more complications that you may have not taken into account when you began the journey.
Not surprisingly, studies show that trans people are quite similar to cisgender women and men when it comes to wanting children and growing their families. While some hormone treatments may make it difficult, it is not impossible from a medical standpoint, especially when thought about EARLY! The best time is before hormone therapy to transition is started. Several fertility treatment options are available that can help them realize their dream of having a biological child. Studies also show that the children that they have do not have any long-term consequences.
However, fertility care can be challenging due to unique circumstances. At Halo fertility, we have a unique focus on transgender patient healthcare. This blog will talk about how transgender individuals and trans men specifically can take care of their fertility and how we at Halo Fertility can help! Read on.
Why Fertility Care is Important for Trans Men
Fertility care is important for trans men simply due to the fact that the process of gender transitioning can impact their fertility and capability to have biological children. Most trans men opt for medical transitioning using hormone treatment. They undergo testosterone treatment where they are given doses of testosterone either as a gel, implant or a shot to suppress their undesired secondary sexual characteristics and accentuate their masculinity.
While there are no studies that show how long-term use of testosterone impacts the fertility of trans men, the use of high levels of chronic testosterone does disrupt ovarian function and can cause ovulation to stop. Additionally, since testosterone is typically given with medication to cause the estrogen and progesterone levels to drop, it may become difficult to conceive normally while on HRT.
Fertility care is especially important if you are considering gender-affirming surgery at some point to transition completely. Surgery to remove your ovaries and uterus (Hysterectomy) will ultimately mean that you will not be able to get pregnant and have children.
Fertility care is also helpful if you want to avoid pregnancy during your transition. By working with a fertility specialist, trans men can ensure that they are physically and emotionally ready to become pregnant before moving forward with conception.
Gender dysphoria can make it difficult for trans men to have normal pregnancies and childbirth. Most trans men opt for top surgery to remove their breasts and this can impact breastfeeding if you are choosing to have a child. It is also common that trans men not to want to get pregnant and give birth. In such cases, fertility care from reproductive medicine specialists can help you understand your abundance of options and take appropriate steps.
Finally, fertility care can help trans men to feel more comfortable and confident in their bodies. By understanding their fertility options and knowing that they can conceive if they wish, trans men can feel empowered and in control of their bodies throughout their transition and beyond.
When Should Trans Men Start Thinking about Fertility Care?
The most ideal time to start thinking about fertility is before you begin your testosterone therapy and when you are in your early adulthood. This is when your reproductive system is the best functioning and you can harvest your gametes (eggs) easily through ovarian stimulation. Once hormone therapy starts, growing gametes becomes more difficult. Similarly, after gender-affirming surgery, it becomes impossible to use your biological gametes any longer.
It’s not uncommon for trans men to want to start a family later in life. For many, this may mean starting to think about fertility care sooner than cisgender women. Most people with a uterus have a reserve of gametes (eggs) that they are born with, the body does not produce more eggs after birth. In trans men, the impact of gender-affirming hormone therapy is that the gonads (ovaries) are suppressed in order to begin masculinization, and they can become difficult to “turn back on”. In some events, if you are above 35, the reserve of eggs becomes quite low as well, leading to much more difficulty when attempting to use them when trying to conceive naturally or with IUI or IVF.
Second, consider your future plans and whether or not you want children in your life. If you know you want children someday, it may be helpful to start thinking about fertility care sooner rather than later. This way, you can ensure that you have the best possible chance of conceiving when the time is right for you.
Third, think about your overall health and well-being. If you have any health conditions that could affect your fertility (such as PCOS or endometriosis), it’s important to get these under control before trying to conceive. The same goes for any medications or treatments you’re taking that can impact your fertility.
Thinking about reproductive options early can help you plan for the future better and in case you choose to have a child at any point, you can make that decision easily and it is not impacted by your transitioning process or other factors.
What are the Fertility Care Options that Trans Men Have?
Trans men have a set of fertility care options available to them. These options depend on their own choices as well as their medical conditions and in which stage of transition they are in. Below we discuss options for having biological children, but achieving a child through the use of donor oocytes is always an option!
Yep, trans men can have natural pregnancies just like cisgender females. Testosterone use while undergoing transitioning can stop your menstrual cycles and prevent normal ovulation within 3-6 months of starting your therapy. However, once you stop taking your hormones, your ovulation and your menstrual cycles can restart and your reproductive system can function normally. You can then conceive through normal means if you are in a relationship with a cis-male partner.
Assisted Reproductive Technology
ARTs are useful for anyone irrespective of gender identity. Trans men who want to have biological children, they can get pregnant via ART too. Using donor sperm or using sperm from a cis-male partner, you can get pregnant via Intra-uterine insemination (IUI) or In-vitro fertilization (IVF). For these to work, you will have to have frozen gametes (eggs) prior to starting transitioning, or if still possible, stop your hormone therapy temporarily to allow for your gametes to be retrieved and used to create embryos.
Gestational surrogacy is another favored option for most LGBTQ+ individuals opting to have biological children. Using your egg and sperm from a partner or a donor, an embryo can be created and this can be implanted in a gestational carrier of your choice. The surrogate then carries the pregnancy to term and gives birth. In this method, the major advantage is that you do not have to stop your hormone therapy. This is also suited for trans men who have opted for gender-affirming surgery, provided they have frozen their gametes prior to having the surgery.
Fertility Preservation is Key
No matter what fertility option you choose, one of the best ways to ensure that you can have your biological child is through egg cryopreservation. Egg freezing is best done before you begin your female-to-male transition. You can also choose to freeze your mature egg or opt for oocyte cryopreservation in which immature eggs are harvested from your follicles and frozen. Freezing oocytes have shown great results and hence this is fast becoming the chosen method of fertility preservation.
You can also opt for embryo cryopreservation where your egg is harvested and fertilized with sperm from your partner or a donor. The embryo is then frozen and stored and can be implanted in you or a gestational carrier at a later stage.
Fertility preservation gives you the freedom to make choices regarding your transition without having to worry about having children later. You can opt for hormone therapy or even genital reconstructive surgery and still have biological children.
Halo Fertility’s Fertility Care Program for Trans Men
Trans men seeking to preserve their fertility have unique fertility care needs that must be taken into account. At Halo Fertility, we are proud to offer a comprehensive fertility care program specifically tailored for trans men.
Our team of experienced fertility specialists understands the unique challenges that come with preserving fertility for trans men and is here to provide individualized care and support every step of the way.
We offer a range of fertility preservation options for trans men, including egg banking and embryo/oocyte cryopreservation and options for using donor eggs. We also offer guidance and support on gestational surrogacy and other fertility care interventions such as IVF and IUI that you may need to meet your family-building goals.
For trans men, fertility care is a very important consideration, especially if you are thinking about having children at any point in your life. While transitioning may be the top agenda item for you, spend some time with an experienced fertility specialist to know what your options are and how to make an informed decision regarding your fertility.
If you’re a trans man considering fertility care, Halo Fertility can help. We offer a range of services to help trans men preserve their fertility. We understand the unique needs of our patients and are here to support you through every step of your fertility journey. Contact us today to learn more about how we can help you achieve your fertility goals.