Assisted reproductive technology (ART) and fertility preservation have made parenthood possible for many individuals and couples, including a growing number of LGBTQ+ families. There are many family building options available to the transgender and nonbinary community in particular, and while the process of gender transitioning may affect fertility and reproductive health, it does not have to remove the possibility of having biological children.

To give yourself as much flexibility as possible in your family building journey, we recommend discussing your reproductive goals with your care team before or during gender-affirming treatment. Read on for a closer look at fertility considerations and potential pathways to parenthood for transgender and nonbinary individuals.

How does transitioning affect fertility?

Gender transition looks different for every person, and fertility considerations vary by treatment option. Here’s how different types of gender-affirming care can impact fertility.

Hormone therapy

Many transgender and nonbinary individuals take hormones like testosterone, estrogen, and testosterone blockers, or anti-androgens, while transitioning. Testosterone suppresses feminine physical traits and induces masculine ones, such as facial and body hair and a deeper voice, in transgender men and some nonbinary individuals. Estrogen increases feminine characteristics like breast development and facial and body hair reduction in transgender women and some nonbinary individuals.

Researchers are still learning about the impact of testosterone and estrogen therapy on long-term reproductive function. While prolonged testosterone and estrogen use often stop sperm production and ovulation, respectively, some evidence suggests that these effects are reversible upon discontinuation of the treatment.

Although hormone therapy may not prevent the possibility of having children biologically in all cases, each situation is different. If you are considering hormone therapy and want to have children in the future, consult with your doctor about the option of freezing your eggs or sperm for future use.

In addition, there is currently no definitive evidence that testosterone therapy will prevent individuals with female anatomy from becoming pregnant. Depending on your family building goals, you may want to discuss contraception options with your healthcare provider.

Gender-affirming surgery

For many transgender and nonbinary individuals, the transitioning journey includes gender-affirming surgery. This treatment option may permanently affect reproductive function. For example, the removal of the uterus in a hysterectomy — which may be performed in a female-to-male transition — prevents the possibility of carrying a child in the future. Having an orchiectomy, or the surgical removal of the testicles, during a male-to-female transition may also impact your ability to conceive.

By taking steps to preserve your fertility before pursuing gender-affirming surgery, it’s possible to bring biological children into the world after a hysterectomy or orchiectomy. Use your healthcare provider as a resource to explore your options.

Fertility preservation treatment

Egg freezing and sperm freezing allow you to pursue gender-affirming treatment while leaving open the possibility of having biological children in the future. 

Sperm freezing helps transgender women plan for a future family before starting estrogen therapy. It is a fairly simple process in which a sperm sample is collected or surgically retrieved. The sample is then stored in vials with cryoprotectant agents that help ensure its long-term viability.

Egg freezing is an option for transgender men. During this process, fertility medications stimulate egg production. Once the eggs are developed, your doctor will retrieve them in a minimally invasive procedure. Your eggs can then be frozen and stored for later use. Depending on how many eggs are yielded, your doctor may recommend pursuing more than one cycle of egg freezing.

Fertility treatment and conception options for transgender men and women

Through the processes of intrauterine insemination (IUI) and in vitro fertilization (IVF), there are several ways that transgender men and women can have children with a partner or as an individual.

Transgender men can use their own eggs, a partner’s, or a donor’s to create a fertilized egg, or embryo. The embryo can then be implanted into their uterus or the uterus of their partner or a gestational carrier, depending on the reproductive ability of each individual. The sperm may come from a partner or a donor.

Transgender women can use their sperm to fertilize an egg from their partner or a donor. The embryo can then be implanted into the uterus of their partner or a gestational carrier.

Using any combination of donor eggs, donor sperm, a surrogate, or a gestational carrier in your family building journey is referred to as third-party reproduction. Note that a gestational carrier carries and delivers a child for an individual or couple and is not genetically related to that child, whereas a surrogate offers both eggs and uterus. In some states, a surrogate automatically receives parental rights as the biological mother, which must be legally terminated after the baby is born. Due to these legal complexities, it is much more common to use a gestational carrier.

Legal considerations

While exploring your third-party reproductive options, it’s critical to research your state’s laws about legal parentage procedures once your baby is born. Movement Advancement Project’s interactive map on parental recognition laws offers a helpful starting point. You should also speak with an experienced LGBTQ+ family lawyer in your state before starting the process.

Financial resources

Fertility treatment is a significant financial investment, and determining how to pay for care is an important part of planning. Here are some resources to explore.

• Many manufacturers of fertility medications, including EMD Serono and Ferring Pharmaceuticals, offer patient assistance programs to reduce some of the expenses.

• Family Equality council has a list of family-building grants that help LGBTQ+ families afford fertility treatment.

• Ask your fertility clinic about financial assistance programs and payment plans.

Alto is committed to minimizing the stress of fertility treatment wherever we can. That includes supporting your financial well-being. If your family building journey includes fertility medications, we’ll work with your doctor, your insurance, and any third-party savings programs to ensure that you receive them at the best price we can find.

Learn more about managing the costs of fertility treatment.

Choose the right fertility pharmacy

Alto is here to support your journey into parenthood. If you choose to pursue any of the fertility options described above, our team of fertility-trained pharmacists will be here at every step. 

Our fertility pharmacy care includes:

• Temperature-controlled packaging that holds refrigerated medications at the right temperature the entire time they are in transit

• Access to fertility-trained pharmacists and resources including injection training guides

• Transparent pricing and support with savings

• An easy-to-use app for all medication management, from delivery scheduling to refill tracking and more

Interested in learning more about how Alto can support your fertility journey? Request a price quote online or reach out through secure in-app messaging.