Many transgender people are interested in having biological children.
How easy or difficult it is depends on a number of factors.
Couples trying to conceive do not always have access to everything they need to make a baby.
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They may need donated eggs or sperm if they only have one or the other.
Stopping testosterone therapy may or may not reverse the effects, thus it can potentially affect fertility.
However, the couple will need donor sperm to get to become pregnant.
If a transgender man or non-binary person assigned female at birth has a partner with sperm things may simpler.
However, the chance of successful conception will be influenced by aspects of both of their transitions.
However, since egg retrieval usually requires a stimulated cycle, this option may not be acceptable to some.
A stimulated cycle can be very dysphoric and cause symptoms such as anxiety and depression.
This also requires a stimulated cycle.
Standard pathways of egg banking are not generally an option for those who transition prior to puberty.
That is not accurate.
In order for someone in this group to become pregnant, she would have to have a uterus transplant.
This is not a surgical option that is currently available for this population.
(There have been reports of a cisgender woman withMRKHgiving birth after a uterus transplant.)
Banking Sperm
Transgender women and transfeminine people can, however, contribute sperm to a pregnancy.
Some bank sperm prior to any medical transition.
This is much more straightforward than the procedure for banking eggs.
This is not generally possible for those who transition prior to puberty.
Still there are some experimental techniques for gamete harvesting under development.
If sperm banking is to be done, it must be done before vaginoplasty.
During vaginoplasty, the testes are removed.
After this point, it is not possible to make sperm.
In addition, some transgender women and transfeminine people have anorchiectomyto remove their testicles without vaginoplasty.
This allows them to reduce the strength of their cross-sex hormone therapy.
Sperm banking must be done before orchiectomy as well.
They will need to use a donor egg and have a surrogate carry the pregnancy.
Transgender Breastfeeding
Breastfeeding can be a very meaningful way of connecting to your child.
Theoretically, all trans people are capable of breastfeeding.
This is because breast tissue is very similar across gender.
Stimulating milk production just requires the right combination of hormones.
In 2018, scientists published the first report of a transgender woman successfully nourishing a child through stimulated lactation.
Discussions about fertility should be an important part of transition care.
When someone wants to preserve fertility, it may be easier to do so earlier on.
Some people put pregnancy above all else.
Others put transition first and foremost.
There is no one pathway to an affirmed life or successful parenthood.
Obedin-Maliver J, Makadon HJ.Transgender men and pregnancy.Obstet Med.
2016;May16;16:106. doi:10.1186/s12884-016-0907-y
