Dust Off The Old Baby-Maker
Pregnancy is not just for cis women. Trans men and nonbinary people who have uteruses can get pregnant and have children. (Soon, transgender women with transplanted uteruses will be able to conceive and carry their own babies, too!) Inclusive language, gender-affirming healthcare, and perinatal support for transgender parents is important for us, our babies, and our families.
Everyone’s body contains both testosterone and estrogen. The balance of these hormones can affect the behavior of different organs and cycles, such as menstruation, pregnancy, and lactation. Changing estrogen levels control the menstrual cycle. When someone has higher testosterone levels, either naturally or because of medications, their estrogen levels are lower and they may not menstruate. However, that doesn’t mean that pregnancy is impossible. Trans men, genderfluid, genderqueer, and nonbinary people can get pregnant—often, without medical interventions.
How Does GAHT Affect My Fertility?
A common myth about transgender people who use gender-affirming hormone treatments (GAHT) says that GAHT makes us sterile or prevents conception. Some doctors may say that going on GAHT means choosing between medical transition and the pregnancy we want. However, that’s not true. GAHT does not make us unable to conceive. This misinformation can result in unplanned pregnancies. (Testosterone isn’t birth control!) This misinformation can also harm those of us who really want to have our own babies but were told that we couldn’t or shouldn’t be parents. Pregnancy is possible for trans people, and we should have fair and equal access to the same resource and supports as cisgender potential parents.
For most people who take testosterone, menstruation stops within six months to one year of beginning GAHT. However, unless the uterus is removed, pregnancy is still a possibility. Dampening the endocrine system’s production of estrogen doesn’t mean you lose your reserve of eggs. Testosterone can make your ovaries go “dormant,” but that is rarely a permanent side effect of GAHT. Stopping testosterone, most people started to ovulate and menstruate again within six months. The eggs released were healthy and normal, and no different from cisgender people’s eggs. The first study that looked at transgender men receiving in vitro fertilization was published in October 2019. It showed that egg quality and quantity were similar between transgender men and cisgender women.
Taking testosterone before a pregnancy does not seem to have any effect on the baby’s health. Babies carried and birthed by trans men and nonbinary people who use testosterone do not have unique health issues, nor are they at risk of developing birth defects or being born early. GAHT might delay pregnancy because it takes some time for menstruation to begin again, but it doesn’t prevent conception once the uterus and ovaries are active again.
What Should I Do If I Want To Get Pregnant?
Although many trans people do not maintain relationships with medical professionals due to discrimination, stress, and poor treatment, pregnancy is a time when healthcare is super important. Finding a doctor, ob-gyn, midwife, doula, or other provider who can help with your prenatal care, birth plan, delivery, and postnatal care is really important for you, your baby, and your family. If you’re not sure where to look for a gender-affirming provider, check out the WPATH directory to find someone in your home state. Whoever you work with should understand your body, use the right words to describe you, and identify you respectfully.
Every pregnancy is different, so ditch the “one size fits all” approach and center your needs. Trans people with uteruses who have sperm-producing partners can probably conceive naturally, after their regular menstrual cycles have returned. Donor sperm and in vitro fertilization (IVF) are both options for people whose partners do not make sperm. These procedures can be expensive. Sperm bank costs vary, but a vial of donor sperm generally costs $900 to $1,000. The insemination procedure itself is often about $200 to $400, though it can be higher, depending on the clinic. IVF, which some people attempt after insemination, is more costly. One round of IVF, which includes hormonal treatments to trigger ovulation and stimulate egg release; collecting, screening, and fertilizing eggs; and implanting the fertilized embryo can cost $12,000 or more per attempt. If you’re not ready to try getting pregnant now, you can bank your embryos or sperm and save them for later.
Some trans people report that going off GAHT in order to get pregnant is difficult. Pregnancy can trigger feelings of body dysmorphia or gender dysphoria. Seeing your body change shape and look more “feminine” is difficult for some people. Others, however, experience pregnancy as a triumph, a celebration, and a joy. As with everyone’s pregnancies, yours will be as unique as you are. Making sure you feel supported both mentally and physically during your pregnancy makes the waiting easier and prepares you to be a better parent before and after giving birth.
Pregnancy is such an exciting (and sometimes scary!) time for parents. For future parents who exist beyond the gender binary, pregnancy can come with some additional considerations. However, when you take control of your own wellness, you can make the best decisions for yourself and your family. Trans people make wonderful parents because we know ourselves deeply. Your future baby is lucky to have you in their corner. The path you take to parenthood is yours to claim, define, and explore.
