If a transgender person wishes to have biological children of their own, a number of factors come in to play. In order to conceive you need a capable uterus, a viable egg and good sperm.
Sperm is retrieved from individuals who are born male, and the uterus and egg would come from those born female. In order to conceive you need one person born male and one born female to provide the egg. You also need an assigned female with a functional uterus who can carry the baby to term.
Couples may not have these three things in place initially so need to take steps to achieve them. Factors that affect the complexity of being able to have biological children for someone who is transgender include:
– Type, status and timing of medical/surgical transition
– Status of preserved sperm/eggs (if applicable)
– Partner’s assigned sex at birth/gender
Transgender men
Transgender men were born female and therefore usually have ovaries and a uterus. This means that it is usually possible for them to conceive and carry a baby to term.
Pregnancy then depends on two things:
– Gender of partner: a male partner can provide the necessary sperm. However, if the partner is female a sperm donor will be required
– Status of transition: removal of the ovaries and uterus precludes pregnancy. Any medical intervention such as hormone intake for transition has to stop for the pregnancy to proceed.
Transgender women
Transgender women were born male. Since they do not possess either ovaries or a uterus they cannot become pregnant. This may change in the future as transplant technology evolves, but this is the situation at the moment.
Transgender women can, however, contribute sperm to a pregnancy.
There are two means to achieve this:
– Banking sperm prior to transition: sperm are easily provided and stored
– Banking sperm during transition: this is not so straightforward, and may require testicular sperm extraction.
Obviously, such measures are only possible where the testes are still in place! Once they are removed in preparation for full hormonal transition, or vaginoplasty there is no going back.
Also, these options are not possible for transgender women who transitioned prior to puberty. However, technology is changing rapidly and there may be other options available to this particular group in future.
In terms of the gender of partners, if a transgender woman has a female partner, providing that the sperm of the transgender woman is viable, they can have a child who shares a genetic heritage with both of them. If a transgender woman has a male partner they will need an egg donor and a surrogate.
Good news for transgender women
A new study in the US shows that it may be possible for some transgender women to produce sperm after starting gender affirming treatment.
Physicians are seeing an increase in the number of people who dismissed sperm-preservation and embarked on hormone treatment. These patients then decided they did want the option to conceive their own biological child.
The researchers, based in Pittsburgh, USA describe the experiences of two transgender women who attempted to produce sperm in mid-transition. One was able to produce sperm after 5 months of halting the transition process; the other wasn’t able to produce sperm.
There is very little information available in this area of what is possible from the human body. Experts say the study is important because it provides a crucial and overdue reference for people to consider. For counsellors the findings are a valuable reference to help patients through gender-affirming transitions. These findings help patients make decisions about parenthood in the future.
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