Fertility for Trans & Nonbinary Folks

As we evolve as people, the family model has evolved with us. The picturesque family of a father, mother, and two children, complete with a white picket fence, is no longer a realistic depiction of what families look like. The socially accepted definition of what a family is has changed in the past few decades. This change in definition has made the idea of family far more flexible for those who aren’t cis or straight.

Through childbearing, surrogacy, adoption, and even fostering, anyone can experience the joys of parenthood and guardianship. Each comes with its own trials and complications, but the wealth of options available for starting a family has helped diversify parenthood in a way that hasn’t been possible in the past.

For folks who are trans or nonbinary, getting pregnant can have a few hurdles you need to jump through to get what you want. However, as long as you plan accordingly and explore your options, you can jump those hurdles together.

For Folks on Testosterone

For trans men and nonbinary people who have decided to go on testosterone treatments, getting pregnant isn’t as tricky as you might assume. Your ovaries don’t stop working completely when you go on T; instead, they enter a sort of sleep state. This means your egg production stalls while you’re on testosterone, but can continue if you stop your treatments for a few months.

There are two main fertility options for trans men and nonbinary parents who are on testosterone.

• Egg Freezing: You can choose to freeze your eggs before you transition to have an eventual partner carry them. This would necessitate IVF to make it possible, which can be costly but does have a high success rate.
• Halting Testosterone: If you want to bear your child and have a partner that can supply sperm, or you want to go the route of using a sperm donor, you will have to halt testosterone temporarily. You’ll need a few months for your body to start ovulating again and then once it does you can start trying. During pregnancy, you’ll have to remain off of testosterone but can go back on it once you’ve given birth.

Egg freezing might be a good option if you feel uncertain about bearing a child. Some people are triggered by the thought of going through the fertility process and pregnancy, so they choose to freeze their eggs in place of going off of testosterone. This way you can either implant those eggs into your partner if they want to bear the child, or you can choose surrogacy if neither you nor your partner wants to go through pregnancy.

For parents who want to bear their child, there will have to be some time that you go off of your testosterone. You may even choose to go through with having a baby before taking hormone treatments so you don’t have to switch on and off. Either way, testosterone doesn’t halt ovulation forever, it just puts it on pause so you can choose later if you want to go through with getting pregnant or not.

For Folks on Estrogen

While trans women and nonbinary folks with testicles cannot bear children themselves, they do have other fertility options that are just as important to consider. It is highly recommended that before you go on hormone therapy, you consider getting your sperm frozen. Hormones can lessen the efficiency of your sperm and can damage the testes after prolonged use.

Freezing your sperm or impregnating your partner before you start hormone treatment is the best way to ensure that you can have a child. Your sperm will be more viable before treatment and, afterward, it isn’t guaranteed you’ll be able to provide viable sperm even if you stop treatment. Discussing your options with your doctor and with your partner can help you figure out what the right decision might be.

For Younger Trans and Nonbinary Folks

If your child or teenager is hoping to use puberty blockers as a way to stall puberty for eventual transition, you might want to discuss with their doctor what their options are. Puberty blockers just stall the effects of puberty so they shouldn’t have any adverse effects on fertility. It will just give them the option to make decisions on their gender identity until they’re sure what they want.

Once they cease using puberty blockers, their assigned gender’s puberty will pick up and they can make fertility decisions before they decide on hormone treatment.

What Else Should You Consider?

The whole fertility process can be a bit overwhelming already, but when you’re having to make decisions based on your gender identity it can be even more so. Whether you have a partner or you’re just wanting to know your options for the future, your doctor can be an important resource to have. It might be difficult to make decisions about your fertility while you’re trying to plan around what makes you feel at peace with your gender identity.

Just having options in the back of your mind can make the process a little easier. You can work with your doctor on a plan that will ensure you have the best options available for yourself and your partner.

No one should be barred from making a family-based upon their identity and whether or not fertility comes easily. Every family is different, so it shouldn’t matter how it comes about. The joys of parenthood may be just around the corner.