Fertility care and family planning before starting gender-affirming hormone therapy

LGBTQ Health
Same-sex pregnant couple holding up their ultrasound scan.

If you're someone who is considering beginning gender-affirming hormone therapy, you might already be aware of some of the fertility preservation options available to you.

Gender-affirming care can involve many different specialties — including family planning. If you'd like to have children who are biologically related to you — either in the near future or further down the line — there are some additional considerations you'll need to make before beginning gender-affirming hormone therapy.

From speaking with a reproductive specialist to egg, embryo and sperm banking, here's what you should know about family planning before beginning hormone therapy.

What is hormone therapy?

If you're transgender or a non-binary or queer person, one of the ways to help your body match your identity might be to begin gender-affirming hormone therapy.

Taking estrogen will encourage the development of what is generally considered female characteristics and will suppress generally considered masculine characteristics. Conversely, taking testosterone will help masculinize your body and will typically minimize feminine attributes.

Because estrogen and testosterone are two of the main hormones involved in fertility and reproduction, altering their levels through hormone therapy impacts your ability to have biological children.

Fortunately, there are steps you can take — ideally before beginning hormone therapy — that can preserve your fertility and increase your chances of having biologically related children if and when you want to.

Preserving your fertility

Even if you're not sure if you want to have biological children, it's a good idea to speak with your gender care team about family planning options available to you. Since hormone therapy can lead to infertility (the inability to get pregnant or conceive a baby and the inability to make sperm), addressing family planning before beginning hormone therapy is ideal. Some of your options include:

Sperm banking

If you are an individual who has sperm, freezing your sperm may be an option. Sperm are collected, and then frozen.

The sperm can later be thawed and used to achieve pregnancy via intrauterine insemination (IUI) or in vitro fertilization (IVF).

If you didn't bank any sperm before beginning hormone therapy, it may still be possible to collect sperm at a later date. This would require pausing taking estrogen, progesterone and testosterone blockers for a period of time long enough to possibly resume making sperm. During that time, your body might producing sperm and it could be collected.

Egg and embryo banking

If you were born with ovaries and have already started puberty, egg and embryo banking are viable ways to safeguard your fertility.

For both of these procedures, you'll need to take fertility drugs to help your egg cells mature. After about 10 to 14 days, the matured eggs are removed via a simple surgery while you're under sedation.

If you decide to bank your eggs, also known as freezing your eggs, the matured egg cells would simply be frozen. For embryo banking, the mature egg cell would be fertilized by sperm in a laboratory — otherwise known as in vitro fertilization. This results in an embryo that can be frozen for later use. 

Mental health considerations

While it's important to consider family planning prior to beginning hormone therapy, it's also necessary to be aware that discussing and pursuing fertility preservation might have a mental health cost.

The processes of collecting sperm and egg cells can exacerbate or cause feelings of gender dysphoria (distress caused by your assigned sex at birth not matching your gender identity). This is due to the fact that they involve taking hormones associated with the sex you were assigned at birth.

You may also feel an urgency to begin the process of gender-affirming hormone therapy. This can make waiting until you're finished with fertility treatments difficult, especially if you suffer from gender dysphoria.

If you're experiencing gender dysphoria or anxiety about waiting to start hormone treatment, let your gender care provider know. Counseling and support groups are some options that can help you cope with your anxiety or distress.

Your future family, your way

Beginning hormone therapy doesn't mean you have to give up being able to have biological children and build your family the way that you want. By speaking with your gender care provider about your family planning options before you start hormone therapy, you can take steps that'll preserve your fertility for whenever you're ready to pursue having a baby.

Next steps:

Make an appointment with an LGBTQ Inclusive Care Providers
Learn more about LGBTQ Inclusive Care at Main Line Health
Mental health challenges in the LGBTQ community

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