Why trans people should take a pregnant pause before transitioning

As an increasing number of people publicly transition genders, we see more and more trans people with kids – from celebrities like Caitlyn Jenner, to people in everyday walks of life like journalist Dawn Ennis. Jeffrey Tambor’s award-winning portrayal of trans mother Maura Pfefferman on Amazon’s Transparent has given America an inside perspective on the lives of, well, trans parents.

While these people and characters transitioned after their children were born, many others transition before they have kids, before their families are formed, and often without consideration for their hopes of having children down the road.

That careful consideration is the biggest hurdle I see when I work with trans patients interested in building a family with genetic ties to them. With some thoughtful conversations and planning, trans people who choose hormone therapy or gender-reassignment surgery can build their families years after their transition is complete. It just takes some thoughtful planning.

As with any conversation about medical procedures, the future should be at the top of the list of considerations for those transitioning. While they may have no interest in having children now, that can change in five, 10, 20 years. That opportunity will close if some key pre-transition steps aren’t taken.

Hormone therapy will in most cases reduce the fertility of anyone – man or woman – and can create irreversible effects that could leave a trans person infertile even without surgery. Gender-reassignment surgery that includes the removal of ovaries or testes ends a person’s ability to produce eggs or sperm and is irreversible.

This isn’t just a “walk-in, day-of” process. Weeks or even months of planning are involved to maximize the likelihood of a successful harvesting of eggs or collection of healthy sperm. This isn’t a conversation to have with a doctor on the cusp of reassignment surgery, it’s something to consider many months or even years in advance.

The main element of the pre-transition solution is to cryopreserve eggs or sperm before transitioning – essentially, freeze them. The eggs and sperm can then be used at any later date for family-building.

I have a patient at California Fertility Partners who froze her sperm nearly 20 years prior to her transition from man to woman. She was committed to becoming the woman she always felt that she was, but she did not want to give up her ability to have her own biological child. So she sought out a laboratory to freeze her sperm to preserve her chance to have a genetically linked child in the future.

Also for consideration before transitioning is conception of a child – either through traditional means or in vitro fertilization (IVF). That further ensures the patient will have children with genetic ties before they transition. With traditional conception options, like sexual intercourse, the person will have a child before or during their transition.

Another option is to create embryos through IVF before transitioning to ensure the successful fertilization of eggs. This offers the assurance of knowing there are fertilized embryos and increases the chances of having a child at a later date.

Of course, none of this is a sure thing. Many factors play into the creation of an embryo and the development of that embryo into a baby, from genetics and environment to the selection of a surrogate and the skill of an experienced fertility specialist.

Certainly there are many reasons anyone may not want to build a family, particularly after transitioning. For some trans people, it is a sensitive reminder of their past; A trans woman using her sperm to create a child could see the process as an eternal remnant from another time in her life.

For those who want to keep that option open the bottom line is simple: Anyone considering hormone treatment or gender-reassignment surgery should take some time to consider the future and their hopes for a family. A consultation with a reproductive endocrinologist to discuss the options available will provide the information needed to help make the decision that’s right for each individual.

Just like with same-sex couples, trans people can have the family they always wanted when they want it; It just takes a little more thought and planning.