LGBTQ

Trans women on hormone therapy are still fertile, study shows, but some have mixed feelings

For trans women, conceiving biological children might be more possible than we thought, according to a new study by Cell Reports Medicine released on January 17, 2023.

The results capsize the presumed medical notion that undergoing hormone replacement therapy (HRT) prevents fertility. The breakthrough isn’t just that participants were able produce viable sperm after pausing hormone treatments, but that forming a family could now become a very real future for many trans women.

“The path to having a biological child is not always easy, and often not in line with preserving gender identity [for trans people],” Norah van Mello, one of the authors of the study, tells Reckon. “If you need to stop hormones to regain fertility, then that would have an effect on maintaining the person’s gender identity.”

Published by Cell Reports Medicine, an open-access journal from Cell Press, the study was done by Amsterdam UMC and the Murdoch Children’s Research Institute in Australia, and showed trans women or transfeminine people are not infertile if hormone treatments are put on pause. For transfeminine people who choose to medically transition, undergoing HRT means being prescribed estrogen in addition to an anti-androgen, which is the testosterone blocker that diminishes sperm production.

In the study, comprised of nine trans women—eight in The Netherlands, one in Australia—four stopped HRT and were able to conceive children with their partners, while the other five stopped HRT to hopefully preserve sperm for future use.

Currently, international clinical guidelines encourage transfeminine people undergoing HRT to consider sperm preservation options, due to eminent claims from leaders of trans healthcare that HRT ultimately leads to irreversible infertility. And while the alleged consensus was that HRT can impair spermatogenesis—the development of sperm cells—the report recalls previous instances that proved against the notion, including one where a patient was able to freeze her sperm after six to ten weeks of HRT cessation prior to a gender-affirming genital surgery.

According to van Mello, “while there are options when it comes to parenting a biological child, there is also still a lot of uncertainty.”

On the opposite side of the spectrum, trans men or transmasculine people who undergo HRT by taking testosterone have successfully been able to give birth, also with the caveat of pausing hormone treatments over the course of several months. Fertility clinic and research organization Boston IVF released a study based on eight years of patient data and found that “transgender men who stopped taking testosterone for an average of four months had similar egg yields to cisgender women when undergoing ovarian stimulation.”

The Boston IVF study revealed very promising futures for transmasculine people who want to bear children, though according to Boston IVF’s medical director Dr. Samuel Pang the numbers of participants in the study was very small. While the overall scientific research regarding gender-related care is still lacking, general understanding around fertility for transfeminine people remains to be even more murky.

The Cell Reports Medicine is a major step towards a clearer foundation for educating transfeminine people about their potential futures as parents, given that transfeminine people on Twitter shared divided feelings about The Daily Beast’s exclusive story on the study. While some have expressed potential infertility to be a hangup, some share that becoming sterile is an important aspect of their medical transition.

“But I wanna be infertile!!!!” said a user on Twitter, while another shared a similar feeling with “Absolutely not for me but good to know.” It is unclear whether some transfeminine people want to be sterile due to gender dysphoria or because they are in a relationship with a person who can carry children and fear getting them pregnant.

For other transfeminine people, the new study doesn’t quite clarify the knowledge they already knew.

“I need some kind of solid [understanding] on if I can have kids or not without having stored material pre-HRT,” said a user on Twitter. “I just want to be able to make a confident decision on getting an orchiectomy so I can get on with my life.”

“I thought we knew this already??” another user said, regarding the study, in which someone else echoed with “I thought this was old news.”

Although the study does not immediately establish clear-cut evidence on what fertility indefinitely means for trans feminine people, there are silver linings regarding the study’s big picture contribution for the trans community.

“For a time, trans women relied primarily on anecdotal evidence to inform themselves about what transitioning meant for fertility,” a user noted on Twitter. “As a result, many fell between delaying HRT, forgoing surgery, or giving up on having children because of spotty data. This is huge for the community.”

Looking at the bright side of what was seemingly on the brink, another Twitter user tweeted “The claim that HRT will make you permanently infertile if you want to stop it has been on its last leg for a while now, but I guess this is the nail in the coffin.”

Still, there are transfeminine people on Twitter sharing their excitement about not losing the choice of reproducing.

“Welp there goes my last mental roadblock about getting HRT,” a user said. “Time to get the [”pink pills”].”

One person shared their emotional reaction to the study, tweeting “Literally crying because there is a chance I can have my own kids at some point in the future now.”

Ari Drennen, LGBTQ Program Director at Media Matters for America, brought attention to the importance of the Cell Reports Medicine study pertaining to the current wave of anti-trans legislation, especially the ban on gender-affirming healthcare for trans youth, wherein infertility or other potential permanent changes are the main talking points for conservatives who are opposed to giving young trans people the agency to transition.

“This research upends the right-wing narrative that has led multiple states to criminalize gender-affirming therapy on the grounds that it leads to permanent sterilization,” Drennen tweeted. “People keep confidently telling me that this is something that all trans people already knew and that absolutely is not true — every trans femme starting hormone therapy is told that it could lead to permanent infertility, and we are not all in your Facebook group.”

Sydney Brauer, Reporter of The Daily Beast’s exclusive story on the Cell Reports Medicine shares her excitement about the study with Reckon “because my partner and I have gone through fertility struggles for the last three years. Just knowing there are more options out there for people when medically transitioning is always a good thing to learn about.”

Cecilia Gentili, author of Faltas and founder of Trans Equity Consulting, recounts seeing her peers not be permanently impacted by HRT, echoing how muddy the extensive understanding of HRT effects is to this day.

“I have [witnessed] transgender individuals becoming pregnant or impregnating their partners while being in a hormone regime [several times],” she tells Reckon. “It is important that this topic is fully researched as trans people want to be in charge and be able to plan for their reproductive lives more and more.”

Denny Agassi

Denny | denny@reckonmedia.com

Denny is a writer, actor, and musician who has co-starred in POSE (FX) and New Amsterdam (NBC), and will appear in the upcoming series City On Fire (Apple TV). Aside from The Grammy, Allure Magazine, PAPER, and more, her recent writing—“He Made Affection Feel Simple”—was published in The New York Times’ Modern Love.

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