Do trans people want genetically related kids? A large study conducted by the clinical research team with Plume Clinic says yes, some do. When we talk about trans healthcare, we often focus on the basics: access to gender-affirming care, hormones, and surgery. But for many trans and gender-diverse people, there’s another important topic that doesn’t get talked about enough—having kids. More specifically, having genetically related kids.
A recent study from Plume Clinic took a closer look at this exact question: how many trans people want kids that are biologically related to them? The results might surprise you—and they carry big implications for how we can support trans people who are exploring parenthood and building families.
Who Was in the Study?
This study included 10,270 trans and gender-diverse adults, ages 18-44. All of them had no prior use of gender-affirming hormone therapy (GAHT). They came from 33 U.S. states and were using Plume Clinic’s telehealth services to begin (GAHT) with either estrogen or testosterone.
Everyone in the study answered a key question: “Do you want to have children with your own genetic material?” They could respond yes, no, or not sure.
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So What Did People Say?
Here’s the data:
- 17.8% said yes—they do want genetically related children.
- 8.4% said they weren’t sure.
- That’s more than 1 in 4 people who are either interested or open to the idea.
The other 74% said no, which is also a valid and important choice. But the key takeaway is that pathways to family-building are clearly on the minds of many trans and gender-diverse folks, even as they’re just starting medical transition.
Who Is More Likely to Want Genetically Related Kids?
The researchers also looked at factors like age, insurance, and sex assigned at birth (SAB) to see who was more likely to say yes (or maybe).
Some patterns stood out:
- People assigned male at birth (AMAB) were 37% more likely to report wanting to have or being undecided about having genetically related kids compared to those assigned female at birth (AFAB).
- People with private insurance were more likely to say yes than those without insurance.
- Folks in their early 20s were the most likely to be open to the idea—more so than those in their 30s and 40s.
- People living in the West and North of the U.S. were also more likely to say yes compared to those living in the South.
Why This Matters
Starting hormone therapy can affect your ability to have biological kids. Estrogen typically lowers sperm production. Testosterone can impact ovulation. And while fertility is possible after stopping hormones and even while taking hormones, it’s not a guarantee. But, let’s not forget that infertility is a common occurrence outside of gender-affirming hormone therapy. Within the cisgender community in the US, upwards of 19% of women aged 15 to 49 and 9% of men aged 15 to 44, struggle with infertility.
That’s why medical guidelines recommend having a conversation with your medical provider about fertility before starting hormones. If someone might want kids down the line, it’s important they know their options now, especially if they’re considering fertility preservation (like egg or sperm freezing).
While hormone therapy can impact fertility, two of the major barriers to fertility for TGD people as with all people, including cisgender folks, are access and cost. For many people, fertility preservation is expensive and hard to access. This is especially true if you don’t have insurance, live in a state with few trans-affirming providers, or don’t have access to specialists in fertility and reproductive health.
In this study, people with private insurance were more likely to say they wanted genetically related children, possibly because they’re more likely to afford the care that makes it possible. Similarly, people in certain regions of the U.S. reported more interest, possibly reflecting better access to supportive, affirming care and resources in those areas.
Adoption as an Affirming Path
Not everyone wants, or is able, to have genetically related children. And that’s okay. Adoption is a real and meaningful way to build a family.
Trans people can legally adopt in every state, though the process can look a little different depending on where you live. Sometimes there are extra challenges, like dealing with bias from agencies or birth parents. But there are also adoption professionals, agencies, and lawyers who are LGBTQ-friendly and ready to support trans families.
There are also different paths to adoption: through the foster care system, private agencies, independent adoptions, or second-parent adoption if one partner is already a biological parent. Each option comes with its own steps, timelines, and costs, but all of them can lead to a loving, stable home for a child.
At the heart of it, adoption is about creating family through love and commitment—not biology. For trans people who want to parent, adoption is as valid, affirming, and powerful as having a genetically related child.
What Should Providers Be Doing?
This study is a reminder that healthcare providers need to check in with their patients about fertility. These conversations can’t be an afterthought.
- If a trans person is starting hormones, they should know how that may impact fertility.
- If they’re unsure about whether they want kids someday, that’s all the more reason to bring it up now.
- And if they are interested in family-building, providers should help them explore their options (such as referrals for egg or sperm freezing, fertility specialists, or adoption agencies).
- Follow best practices and guidelines from current literature in regards to hormone therapy in the setting of fertility preservation if desired.
These aren’t just medical decisions, they’re life decisions. And every trans person deserves the opportunity to make them on their own terms.
Parenthood can look different for everyone. But for trans and gender-diverse people, it’s often surrounded by extra challenges—medical, financial, and social.
Supporting trans people means supporting all parts of their journey, including the possibility of becoming a parent. So whether someone is starting hormones at 18 or 38, whether they know they want kids or are still figuring it out, their medical providers should be ready for this important conversation.
