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Fertility Options for Transgender Men and Women
Are you a transgender male or female interested in having genetically related children today? Or at some point in the future? Dr. Samuel Pang, Medical Director at IVF New England, has been treating gay and transgender men and women since 1998. He spoke with FertilityAuthority about options for preserving your fertility and building your family before and after transitioning.
Question: I’m going to transition, what are my options to have genetic children in the future.
Answer: According to Pang, have a conversation with your physician and let them know you’d like to freeze your eggs or freeze your sperm before you undergo any type of treatment – surgery or hormonal – that may render you incapable of producing sperm or eggs in the future.
A man who has transitioned to a woman and has banked sperm can use the sperm with IUI if she is in a relationship with a woman. If she is in a relationship with a man or is single, she can use an egg donor and a gestational carrier.
A woman who has transitioned to a man and has frozen eggs can use donor or partner sperm and a gestational carrier if he is single or in a relationship with a man. If he is in a relationship with a woman, they can undergo reciprocal IVF, whereby the partner is inseminated with an embryo created by donor sperm and the frozen eggs.
Q: I’ve already started my transition with hormone therapy, but did not freeze my sperm or eggs prior. What's next?
A: Unfortunately, not all doctors present options for fertility preservation before you transition. If hormone therapy is halted, there is the possibility that sperm production may resume and ovaries will ovulate again. What’s unknown, because this is a new field, is how long can you be on hormone therapy before it could potentially become reversible. “I have had transgender men who have been on testosterone therapy for up to 18 months, and when we stopped his testosterone therapy he began ovulating and menstruating, which then allowed us to stimulate his ovaries and retrieve his eggs,” Pang says. However many men are reluctant to stop testosterone therapy because it can be psychologically distressing; you’ve been living as a man, and now facial hair stops growing and you start menstruating. It’s an option, but it’s not ideal. That’s why it is so important to consider fertility preservation before you initiate the transition.
Q: I’ve had or will have surgery to remove my ovaries or testicles. Can I still have biological children?
A: If the ovaries are you removed you’ll no longer produce eggs, and if the testicles are removed you’ll no longer produce sperm. That’s why it’s important to preserve your fertility prior to surgery. If you’ve already had surgery, egg donation or sperm donation is an option to build your family.
Q: I have a child under the age of 18 who is considering transitioning. What are options for preserving his or her fertility?
A: Children are coming out and transitioning at younger ages. If the child is post puberty, eggs or sperm can be retrieved and frozen. “The biggest obstacle would be where young boys or girls are given medications to suppress puberty,” Pang says. “A trans girl would be given drugs to prevent her from undergoing puberty so her penis and testicles won’t grow and she won’t produce testosterone. If they don’t undergo puberty, that would prevent a huge challenge for fertility preservation.”
Q: Can a child under the age of 18 preserve his or her fertility?
A: “Most recently I had a phone call with a mother of a 14-year-old transgender son who has been considering transition from a girl to a boy for the last five years, and he was thinking about preserving his eggs before he begins hormone therapy. That is great,” Pang says. “But there are issues because he’s still a minor. We treat minors who have cancer and need fertility preservation, so we’ll use that model.”
Q: How do I find a transgender-friendly fertility doctor?
A: Not every fertility practice is GLBT friendly, so referrals are a good place to start. And Pang emphasizes you don’t want a fertility practice that simply treats the GLBT community because it’s good for business, you want a practice whose entire staff is welcoming and culturally sensitive.