The choice to transition is a very important decision for transgender people. It can change the way they see themselves and of course, the way the world sees them. Hormone replacement therapy or HRT is the beginning of the journey of transition and many opt to do this first and then go for gender-affirming surgeries later in the day.
While hormone replacement therapy (HRT) can be a life-changing experience, it can also have an impact on fertility. While it is not the case that they cannot conceive through natural means after starting HRT, it can often be quite complicated given how hormones can change the way the bodies function. Most trans men will stop menstruating within 3-6 months of starting HRT. Sperm production is also impacted and the quantity and motility of the sperm are reduced while on hormone treatment.
Fertility is a question that needs to be dealt with seriously in the case of people who are opting to transition. This blog post will explore the fertility implications of HRT for transgender individuals and what you need to know before starting a fertility treatment plan.
What is HRT?
Hormone replacement therapy (HRT) is a treatment option for transgender individuals who wish to transition to the opposite gender. HRT involves the use of hormones to alter the secondary sex characteristics of an individual, such as the development of breasts or facial hair. For transgender men, further steps may also involve the removal of the uterus and ovaries or at least suppressing ovarian function. In the case of transgender women, gender-affirming surgery is usually performed only after a prolonged period of HRT.
Gender dysphoria is one of the debilitating effects of being a transgender individual where you do not feel comfortable in the body you are born with. The primary and secondary sexual characteristics that you present may prove to be challenging for you and can cause major psychological issues in transgender individuals.
Testosterone therapy is used for transgender men to suppress secondary sexual characteristics and give them a more masculine identity. Testosterone can be consumed orally, subcutaneously, or via intramuscular injections.
Estrogen therapy is used for trans women where it suppresses the function of testosterone and alters their secondary sexual characteristics like breast formation and hair growth patterns. Estrogen reduces gonadotropin secretion by the pituitary glands and also reduces the effect of androgens in the body.
Fertility preservation is an important part of a transgender individual’s transition, especially for those who wish to have children in the future. There are a variety of fertility treatments available, including in vitro fertilization (IVF), artificial insemination (AI), and egg or sperm donation. It is important to discuss your fertility options with your doctor before starting any hormone therapy, as some treatments may impact your fertility.
How Does HRT Affect Fertility?
There is a common misconception that gender-affirming hormone therapy will make transgender individuals infertile. However, this is not the case. HRT will not cause permanent infertility, but it may make it more difficult to conceive.
The reason for this is that HRT can suppress ovulation in trans men. Ovulation occurs when the ovaries release an egg into the fallopian tubes. While the research is unclear on the long-term effects of hormone therapy, ovulation stops while the person is on HRT. In most cases, however, trans men can still conceive and have a normal pregnancy when the HRT is stopped for a while and the ovarian function returns to normal. However, prolonged exposure to testosterone may affect the maturation of the eggs and can also impact the follicles in the ovary.
In the case of trans women, exposure to high levels of estrogen can impact spermatogenesis and can also reduce the sperm count and the health of the testes. This can make it difficult to conceive via natural means,
If you are interested in starting a family, it is important to talk to your doctor about fertility before starting HRT. They will be able to help you create a fertility treatment plan that takes into account your unique situation.
How can Someone on HRT Ensure Fertility?
If you’re transgender and considering starting hormone replacement therapy (HRT), you may be wondering how it will affect your fertility. HRT can certainly have an impact on your fertility, but there are steps you can take to ensure that you remain fertile while on HRT.
First and foremost, it’s important to talk to your doctor about your fertility before starting HRT. Your doctor can help you understand how HRT may impact your fertility and what steps you need to take to protect your fertility.
Fortunately, there are ways to protect your fertility while on HRT. If you’re concerned about maintaining your fertility while on HRT, be sure to discuss these options with your doctor:
In many cases, natural conception is still possible in trans people even after they begin the process of gender transitioning via HRT. Needless to say, this does not work if you have had gender-affirming surgery like an orchiectomy (removal of testes) or removing the uterus and ovaries.
In most cases, temporarily stopping HRT can return the hormone levels to normal and can reverse temporary infertility. You can thus proceed to try via natural means to get pregnant. You may however still need help from reproductive medicine experts as the prolonged exposure to hormones may have impacted your fertility and you may need IUI or IVF to get pregnant.
In most cases, this is what most fertility specialists would recommend. If you’re worried about how HRT will impact your future fertility, you may want to consider freezing your eggs or sperm before starting HRT. This way, you’ll have the option to use your own genetic material to have biological children in the future, even if HRT has impacted your fertility.
It is best to consider freezing your sperm or eggs before you begin hormone therapy. This will ensure that you have healthy gametes that can be used at a later date. In some cases collecting and freezing oocytes from your ovaries is also done as an alternative to freezing mature eggs. In the case of pre-pubescent transition, collecting testicular tissue is also done as the testicles are not producing sperm at the time of transition. However, the procedures to create sperm samples from testicular tissue still remain experimental.
Whatever you decide, it’s important to talk to your doctor about your fertility before starting HRT. By doing so, you can make sure that you’re taking the necessary steps to protect your fertility and ensure that you can have children in the future if you so desire.
How can a Trans Person on HRT have Children?
If you are a transgender individual who is currently taking hormone replacement therapy (HRT), you may be wondering if it is possible to become pregnant. The good news is that it is indeed possible for trans people on HRT to become pregnant, though there are some things to keep in mind before starting a fertility treatment plan.
In some cases, trans people on HRT may be able to conceive through artificial insemination using donor sperm or an egg. This option allows trans women and men on HRT to experience pregnancy and childbirth without having to undergo surgery. You may however need to stop taking hormone medications during the duration of the pregnancy.
For trans people on HRT who wish to conceive, another option is gestational surrogacy. This involves transplanting an embryo created using donor eggs and the person’s own sperm into the uterus of a surrogate mother.
In both these cases, cryopreservation of eggs, oocytes, sperm, or even the embryo before you begin the process of transition can have better results.
If you are a transgender individual who is interested in starting a family, it is important to be aware of the fertility risks associated with hormone therapy. However, this does not mean that fertility treatment is not an option for you.
There are many fertility treatments available that can help you have a healthy pregnancy and delivery. With the right fertility treatment plan, you can achieve your dreams of becoming a parent. Talk to your doctor about your options and make sure to ask about any potential risks so that you can make the best decision for your health and well-being.
At Dreams Fertility, it is our mission to help aspiring parents achieve their dream of raising a family. Our fertility specialists are experts in guiding you through the various fertility treatments available today and how to choose the best option that works for you. Schedule a consultation today for the best-in-class fertility care that you deserve!
Dr. Luis Murrain joined Dreams Fertility in 2021, providing specialty services in Fertility and Reproductive Genetics. With a shared vision that everyone deserves to have the family of their dreams, we are dedicated to helping all of our patients. We believe that families come in all shapes and sizes, and all of them are beautiful. We are proud to have a long history of providing services to all, including gay, lesbian, and transgender individuals and couples on their road to parenthood.