Egg freezing is an amazing technology for transgender men and gender non-conforming people who may want to have genetic or biological children. Here’s our guide to gender transition and fertility, and how egg freezing can help achieve your goals.
While we’ll be using the phrases “transgender men” and “trans men” here, this guide applies to any person that may have been assigned female at birth (also known as AFAB) undergoing testosterone treatment.
Gender transition and fertility
The term “trans man” is often used to refer to people who were assigned female at birth (AFAB) who identify with a male or masculine gender identity. While not all trans men choose to transition medically, many will undergo hormone replacement therapy (HRT) with testosterone to align their secondary sexual characteristics, including facial/body hair, muscle mass and a deeper voice, with their gender identity.
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Over time, testosterone therapy usually leads to anovulation (no ovulation) and amenorrhea (no menstrual periods). According to research, greater than 90% of trans men taking common forms of testosterone stop having periods within 6 months.
It’s certainly possible for trans men to get pregnant and have healthy babies. In one survey of pregnant transgender men, 80% of the respondents reported getting their periods again within 6 months of stopping testosterone treatment. It’s super important for anyone on testosterone treatment to understand that it’s not a form of birth control.
But, the effect of long-term testosterone treatment on fertility is mostly unknown. A small study published earlier this year determined that, in a group of 52 trans men, ovarian function was maintained after one year of HRT, though AMH levels (the hormone levels that indicate egg quantity) had dropped. However, trans men who undergo medical transition are likely to be taking testosterone for the remainder of their lives, and there’s no research at present that can clue us in to what happens after five, ten, or more years. Plus, the impact of testosterone treatment on egg quality—the genetic health of the eggs—is unknown.
That’s why transgender men who want to have biological families in the future may consider egg freezing either prior to starting testosterone or early in hormone therapy.
The egg freezing process for transgender men
Ideally, egg freezing would happen before a trans man starts HRT, but in reality, it doesn’t always happen that way. And a 2020 study of egg freezing outcomes suggests that trans men can still have successful fertility or fertility preservation treatment, even if they’ve been on testosterone prior to treatment.
Testosterone causes the body to stop maturing and ovulating eggs, and the goal of egg freezing is to mature and retrieve many eggs. This means transgender men taking testosterone will need to stop hormone therapy and resume their menstrual period before freezing their eggs. This can be difficult, because once they stop taking testosterone, a trans man may experience a reversal of the masculinizing process they’ve begun.
Relatedly, trans men should have ample mental health support during the egg freezing process. The typically mild side effects of egg freezing—such as breast tenderness, bloating, and a feeling of fullness in the ovaries—may be especially uncomfortable or emotionally painful for a person who potentially experiences gender dysphoria.
Apart from these considerations, the process of egg freezing for transgender men does not differ from that of other patients. Over the course of 8–12 days, beginning with day two of the period, patients will inject themselves with hormones that stimulate the ovaries to produce multiple eggs. After the eggs have matured, doctors will remove them from the ovaries in a brief outpatient process known as the egg retrieval, and they’ll be cryopreserved in a laboratory. Once frozen, eggs can be stored indefinitely.
How transgender men can use their frozen eggs
The beautiful thing about egg freezing for transgender men is that it offers so many options for creating a family. Egg freezing protects the cryopreserved eggs from any damage as a result of gender-affirming hormone therapy, and gives trans men more options for family-building later.
As we mentioned above, trans men can (and have) carried pregnancies, and can use their own eggs with IVF to achieve a healthy pregnancy. The important thing to note about this option is that, because research has demonstrated testosterone can be damaging to a growing fetus, trans men are advised to stop hormone therapy before and for the duration of their pregnancies.
On the other hand, many transgender men don’t want to carry a pregnancy, or may choose a hysterectomy (surgery to remove the uterus) as part of their transition path. After freezing their eggs, a trans man can use a gestational carrier (surrogate) to carry and birth their genetic child. Or, for trans men whose partners have uteruses, reciprocal IVF is an exciting option. During reciprocal IVF, an egg from one partner, fertilized with donor sperm, is transferred into the uterus of the other partner, allowing both partners to have a biological “hand” in the baby’s life.
For those that may want to use a surrogate in the future, there’s an extra step: screening required by the FDA, including STI, HIV, and hepatitis testing. This screening needs to be done prior to the egg freezing process, and will be discussed with you during your consultation.
Does insurance cover egg freezing for transgender men?
In the United States, most employers and insurance companies don’t cover egg freezing. According to our research on benefits, only 3% of respondents to our survey reported that their employers covered egg freezing. But, be sure to check with your insurance plan to understand your coverage, and with your employer to see if they work with any third-party fertility benefits companies. And it’s important to note that, even in cases where the procedure isn’t covered, the medications may be, which can mean a difference of $2,000–$5,000 per cycle.
We are starting to see that change, thankfully. New legislation in New York State, for example, will require many insurers to cover IVF and medically necessary egg freezing (such as in the case of a cancer diagnosis), and patients will have access to those benefits regardless of gender identity, sexual orientation, or relationship status. Right now, it’s not completely clear, but it’s possible (and we’re hopeful!) that the “medically necessary” category will include the transgender community.
We’re working to make fertility preservation more accessible to everyone, by reducing the cost of egg freezing, using frozen eggs, and other fertility treatments by 40% or more. Plus, our team can walk you through the process of understanding what will be covered by insurance. Learn more.
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Here at Extend Fertility, we have experience working with transgender patients, and look forward to the opportunity to help more people of all identities preserve their fertility options. If you’re a trans man interested in learning more about egg freezing, contact us to speak with a fertility advisor.
Updated with new research on June 16, 2020.