Transgender Men Transition And Fertility

A transgender man is a term used to refer to someone who was labeled female at birth but chooses to identify as a male. Not all trans men undergo a medical transition. However, many decide to go for testosterone replacement therapy to make their secondary sexual characteristics align with those of the sex they identify with. These treatments and surgeries often affect the fertility health of transgender men and prove an obstacle to becoming parents. Hence, trans men who would like to have biological children in the future may want to go for egg freezing. That is, either before they start taking testosterone or early in the hormone replacement therapy. Coastal Fertility is a leading LGBTQ+ friendly fertility clinic in California and has helped many transgender men achieve parenthood. Let us learn how the transition treatments impact transgender fertility and how freezing your eggs can help.

The Impact of Testosterone Treatment on Transgender Fertility

With time, testosterone therapy often results in amenorrhea (no menstruation) and anovulation (no ovulation). Studies have shown that over 90 percent of transgender men on testosterone stop having menstrual periods within six months.

Sure, transgender men can still become pregnant and have healthy children, even after medical transition. In a study of pregnant trans men, 80% of the participants reported they start having their menstruation within six months of pausing testosterone treatment. It is very important for transgender men taking testosterone to know that it is not a form of contraception.

However, the long-term impact of testosterone treatment on fertility is not yet known. A recent study was presented in the Endocrine Society Annual Meeting 2019. It showed that ovarian function was still maintained in transgender men after a year of hormone replacement therapy. However, there’s a decrease in the levels of AMH (the hormone that shows egg quantity). But transgender men who choose to transition medically may need to be using testosterone for the rest of their lives. And there’s currently no study that can give us a clue of what will occur after 5, 10, or more years of testosterone use. Additionally, we are yet to find out the effects of long-term testosterone treatment on egg quantity.

The Egg Freezing Process for Trans Men

Ideally, a transgender man would commence testosterone treatment after undergoing egg freezing to preserve their fertility. However, the truth is, it does not always occur that way. A study of egg freezing results indicates that even if trans men have been taking testosterone before treatment, they can still have a successful fertility preservation treatment (i.e., egg freezing).

Testosterone (T) prevents the body from maturing and releasing eggs. The aim of egg freezing is to mature and harvest as many eggs as possible. This implies that trans men on testosterone will have to pause the therapy and restart their menstruation prior to freezing their eggs. We understand this may be hard to do. These men may witness a reversal of the masculinization process they have started once they go off testosterone.

As an LGBT friendly fertility clinic in California, we recommend transgender men have adequate mental health support when freezing their eggs. There are many common side effects of egg freezing. To name a few, bloating, breast tenderness, and a feeling of fullness in the ovaries. These symptoms can be very uncomfortable for an individual who may also be going through gender dysphoria.

Aside from these considerations, the egg freezing process for transgender men is the same as that of other patients. For 8 to 12 days, starting with the second day of the menstrual period, the patients will have to self-inject fertility hormones (hCG). These hormones will encourage their ovaries to produce many eggs. Once the eggs are mature, the doctor will harvest them from the ovaries via a minimally invasive procedure called the egg retrieval. These eggs then undergo cryopreservation (in liquid nitrogen) in the laboratory. You can then store the frozen eggs for as long as you want.

How Transgender Men Can Utilize Their Frozen Eggs to Preserve Their Fertility

One great thing about egg freezing for trans men is that it provides them a lot of options to have children. Egg freezing prevents damage to the eggs as a result of hormone replacement therapy. Hence, it offers Transgender men several options for building a family in the future.

As mentioned earlier, it’s still possible for trans men to have and even carry a pregnancy. Transgender men can also use their own eggs to create a healthy pregnancy through IVF. The key thing to remember about this option is that studies have shown that testosterone can damage a fetus. Hence, we advise Transgender men to quit testosterone treatment prior to and over the course of their pregnancies.

On the other hand, some transgender men do not wish to carry a pregnancy. Some even decide to undergo a hysterectomy (surgical removal of the uterus) as a part of their medical transition. Once their eggs are frozen, a transgender man may use a Gestational Surrogate to help carry and deliver their biological baby. Alternatively, transgender men whose spouses have a functioning uterus may consider reciprocal IVF as a fertility treatment option. During reciprocal IVF, also known as Co-IVF, the egg of one partner is “combined” with donor sperm. The resulting embryo is transferred into the other partner’s womb. This process gives both partners the chance to biologically participate in the child’s conception.

For trans men who will be using a Gestational Carrier in the future, there is one more step to take. That is, medical screening for infectious diseases. The Food and Drug Administration (FDA) requires that those going for egg freezing undergo testing for transmittable infections, like HIV, syphilis, hepatitis. The screening has to be carried out before the egg freezing process.

Does Insurance Cover Egg Freezing For Trans Men?

Most US employers and insurance providers do not cover fertility preservation options, such as egg freezing for transgender men. In a survey on employee benefits, only 3 percent of participants reported that their employers provide coverage for egg freezing. However, it’s important that you check with your insurance company to fully understand your coverage. Moreover, you should enquire with your organization to find out if they’re in partnership with any 3rd party fertility benefits companies. You also need to note that even in cases where there’s no coverage for egg freezing, the medications may be covered. That means you can get to save between $2000 to $5000 per cycle. If you are not sure whether your insurance covers fertility preservation or not, a financial counselor at our California fertility clinic will help you to figure these things out.

The good news is, we are beginning to see changes in insurance fertility coverage. For example, New York has passed a law that will require that insurance companies cover in vitro fertilization (IVF) and non-elective egg freezing (like in the case of cancer diagnosis). And all patients – regardless of their sexual orientation, gender identity, or relationship status – will be able to enjoy those benefits. It is not yet clear, but hopefully, the “medically necessary category” will include Transgender men and women.

What is the best course of action for you?

As an LGBTQ+ friendly fertility clinic in California, we believe everyone deserves to fulfill their dream of parenthood irrespective of their gender identity. Undoubtedly, egg freezing is the best viable option for Transgender men to preserve their fertility and start a family after the completion of their transition.

If you wish to learn how Coastal Fertility can help you with egg freezing as well as other LGBTQ family building options such as IVF, IUI, and surrogacy, simply schedule a consultation with us. We encourage you to explore our website to have a chat with our team.