Contrary to widespread misconceptions, medical transitioning does not necessarily produce sterility in trans people. Provided that a trans person hasn’t undergone gender-affirming surgeries that involve the removal of the ovaries or testes, even the use of cross-sex hormone therapy that can impact fertility to varying degrees may not produce a permanent or complete impairment, and the effects of HRT on the viability of reproductive material can differ widely between individuals. For these reasons, HRT is not at all a reliable method of contraception for trans people (Amato, 2016), and trans people using hormone therapy can experience unintended pregnancies (Obedin-Maliver & Makadon, 2016).
For trans people who do intend to have genetically related children but also wish to pursue surgeries involving gonadectomy, the cryopreservation of sperm or eggs offers a way to make use of their own reproductive material following surgery. One of the still-open questions regarding transgender fertility preservation is how long those taking HRT would typically have to pause their hormone therapy in order to achieve an optimal quality of gametes. For instance, one study found that trans women and transfeminine people who discontinued their HRT for an average of 4.4 months were able to produce semen of a quality comparable to those who’d never taken hormone therapy (Adeleye et al., 2019).
Last year, I wrote about the findings of a study of fertility treatment in trans men using ovarian stimulation, a process that medically induces the release of eggs that are then retrieved and frozen. 61% of the trans men in the study had been taking testosterone, for an average of 3.7 years, and had discontinued testosterone for an average of 4 months before undergoing ovarian stimulation (Leung et al., 2019). The trans men in this study were ultimately able to produce an even greater number of eggs for preservation than the cohort of cis women who also underwent ovarian stimulation, and the authors concluded by raising the question of “whether ovarian stimulation can be done with any measure of success without the cessation of testosterone” – in other words, whether trans men actually need to pause their HRT at all before this fertility treatment.
A recent case report brings us closer to answering that question. Cho et al. (2020) describe the results of ovarian stimulation in a 28-year-old trans man who had been taking testosterone for three years, but unlike the previous study, this man began receiving treatment only one week after discontinuing testosterone. His total time off of HRT during fertility treatment was 24 days, or three doses of testosterone, and 11 mature eggs were retrieved and preserved before resuming HRT.
Fertility preservation treatments such as these are a balance of competing needs for trans people: even if we wish to retain the option of having children with our own genetic material, we also generally wish to avoid delaying or interrupting HRT. Discontinuing HRT to undergo fertility treatments can produce a worsening of gender dysphoria (Armuand et al., 2017), and some trans men will choose against fertility preservation specifically due to the need to pause testosterone (Leung et al., 2019). If it should turn out that successful results such as those seen in this recent case report can be obtained consistently, this could substantially lower that barrier to fertility preservation for trans men and transmasculine people, allowing them to save their reproductive material with minimal disruption to their transition treatment. ■
