Transitioning is a major decision for many transgender individuals. Transitioning medically is a long process and it can have an effect on various parts of life.
Medical Transitioning with Hormone Replacement Therapy (HRT) is the process that helps transgender people transition by aligning their secondary sex characteristics with their identity. HRT is also used to help alleviate some of the negative effects of menopause in cisgender women.
If you are a transgender person considering HRT in order to transition, and you are also considering starting a family at some point in your life, there are a few things to keep in mind. In this blog post, we will explore some of the risks and possible complications associated with HRT treatments and pregnancy. We will also provide some tips on how to best prepare for a healthy pregnancy and what are some of the other reproductive options you have for you to have biological children. Read on!
What is Hormone Replacement Therapy
Hormone replacement therapy (HRT) is a treatment that replaces the hormones that your body is not producing enough of. This can be due to surgery, such as a removal of ovaries/testes, or simply because your body is not producing enough of the hormone. HRT today is more commonly used to help transgender patients transition.
There are a few different types of hormone replacement therapy (HRT) treatments for transgender men and women. Testosterone therapy is usually prescribed for trans men, which can be done through injections, gels, patches, or implants. This therapy can help to masculinize features, deepen the voice, increase muscle mass and strength, and decrease fat deposits. Testosterone therapy can also counteract the effect of estrogen and progesterone that are present in the body, and this impacts menstrual function as the ovaries are impacted. Both ovulation and the menstrual cycle typically stop within 4-6 months of starting high dose testosterone therapy.
Estrogen therapy is also used for trans women which can be done through pills, patches, creams, gels, or shots. This helps to feminize features, decrease muscle mass and strength, increase breast development, and redistribute body fat. Estrogen therapy can impact sperm health in individuals and can reduce the mobility and quality of the sperm being produced. There are also a few other types of medical therapy that are less common but may be used in some cases, such as progesterone therapy, anti-androgen therapy, and leuprolide.
It’s important to note that HRT is not a “cure” for gender dysphoria (the distress that comes from feeling like your assigned gender doesn’t match your true gender), but it can help alleviate some of the symptoms. HRT is also not without risks – there are potential side effects with any type of hormone therapy, so it’s important to talk to your doctor about the risks and benefits before starting any treatment.
Typically, HRT can cause many issues such as mood swings, hot flashes or night sweats, decreased sex drive, and vaginal bleeding. HRT is also known to cause weight gain, blood clots in veins and lungs, high blood pressure, as well as increased risk of heart disease/heart attacks.
Additionally, if you’re considering conceiving a child while on HRT, there are some special considerations to take into account – again, speak with your doctor about this before making any decisions.
Transitioning and Pregnancy – How does it Affect Fertility?
It is important to note that not all transgender individuals desire or plan to have children, but for those who do, it is vital to understand how hormone therapy may affect fertility. Transgender women who are taking estrogen and/or progesterone may experience a decrease in fertility. Testosterone and androgen levels in their bodies lower due to the androgen blockers and the estrogen therapy that they take. This can cause temporary infertility where the sperm produced is not capable of fertilizing the egg. The sperm count and the quality of the sperm are lower due to long-term exposure to estrogen and progesterone.
For trans men, fertility is affected by testosterone therapy. This is because testosterone can suppress ovulation and block the production of eggs. Testosterone can also cause changes in the lining of the womb, making it less hospitable for a fertilized egg. However, it is important to note that some transgender men may still be able to conceive even while on testosterone therapy. If you are considering starting testosterone therapy and wish to preserve your fertility, it is important to speak with your doctor beforehand.
That said, it is important to remember that every individual is different and will experience transition and effects on fertility in their own unique way. HRT can be a sort of natural form of contraception especially due to the fact that the regular reproductive function has been disrupted. If you are considering starting or continuing hormone therapy it is important to speak with your doctor about the potential risks and how they might affect your fertility.
What Fertility Options do Transgender People on HRT have?
There are several fertility options available to transgender people who are undergoing hormone replacement therapy (HRT). The most common option is to use assisted reproductive technologies (ART) such as in vitro fertilization (IVF). IVF can be used with either the person’s own eggs or donor eggs. Another option is intrauterine insemination (IUI), which can also be done with either the person’s own sperm or with donor sperm.
There are also a few options for people who are not able to or do not want to use ART. One is to stop HRT temporarily to allow the person’s body to ovulate and produce eggs on its own. This typically takes several months. In most cases, stopping HRT temporarily seems to reverse the effects. Trans men who stop testosterone therapy should restart their menstrual cycles within 4-6 months of stopping HRT. Often in such cases, you may also have to undergo some form of fertility treatment to regularise ovarian function such as using follicle-stimulating hormones(FSH) to stimulate the ovaries for egg production.
The final option is to use a gestational carrier to carry the child. This involves finding someone who is willing to carry and deliver a baby for the person or couple. The gestational carrier will carry the pregnancy to term. The implantation can happen using the embryo created from the egg and the sperm of the partners or from the donor egg/sperm.
Why is Working with a Fertility Specialist Important Before and During HRT?
There are a few things to consider before starting HRT if you hope to one day have children. Your fertility potential will be affected by the hormones you take, so it’s important to talk with a fertility specialist about your options before starting treatment.
If you want to preserve your eggs or sperm for future use, you may need to start thinking about this before you get started on your HRT. A fertility specialist is the best person to help you understand the various options of fertility preservation you have such as egg or oocyte freezing, sperm freezing, or even embryo freezing.
It’s also important to work with a fertility specialist during HRT so they can monitor your hormone levels and help ensure that they remain within a safe range. This is especially important if you are taking higher doses of hormones or using injectable hormones, which can have more unpredictable effects on the body. The effect that HRT is going to have on your body can only be properly assessed by a thorough checkup including understanding medical history and family history as well as tests to assess ovarian and uterine health or testicular health prior to starting your HRT. A fertility specialist will be able to advise you on the best course of action if you have pre-existing issues like PCOS or premature ovarian failure and other symptoms that can lead to infertility before HRT begins.
There is a lot to consider when it comes to HRT treatments for transgender people who want to get pregnant. However, with the right information and guidance, it is possible to have a healthy and successful pregnancy. If you are considering HRT treatments and trying to conceive, be sure to speak with your doctor about all of your options and what is best for your individual situation.
Halo Fertility can help if you have questions! We are experts in helping LGBTQ+ people navigate the complex landscape of fertility treatments to fulfil their dreams of having a family. Schedule a consultation with our fertility specialists today!