Routes to parenthood: information for trans prospective parents

For many trans* people, options for parenting can be similar for other LGBT people. Trans people can apply to be adoptive or foster parents and should be assessed in the same way as any other prospective parent. Click here to find out more about adoption and here to find out more about fostering. You may also want to read Harriet and Lizzy’s story of becoming transgender adoptive parents and listen to this podcast on adopting from a trans perspective.

For trans people who want to have children that they are genetically linked to, choices can be a bit more complicated. Below is some brief information on some of your options.

Gamete storage

Gamete storage is the storage of eggs or sperm for future use, usually by cryopreservation (freezing). Best practice guidance from the NHS suggests that trans people of child-bearing age should be given advice on gamete storage before they start hormone therapy and/or before they have surgery that would affect their fertility. However, gamete storage is often not available on the NHS so there is likely to be an upfront cost for harvesting of sperm or eggs at a private clinic, along with an annual cost for continued storage.

When you are starting hormone therapy or preparing for surgery it may be difficult to imagine a time when you would want to have children. But gamete storage should be seen less as a definite statement of intent and more as keeping your options open. If you decide to have your sperm or eggs frozen, these could then be used in the future for IVF treatment, either with a partner or using a surrogate.  Click here for more information about using a fertility clinic and here for more information about surrogacy.

Pregnancy for trans men and other trans people who have a uterus

Whilst some trans people who were assigned female at birth will opt to have a hysterectomy, others do not have this surgery. If you still have a uterus and ovaries, you may be able to get pregnant, even if you have been taking testosterone.

It has been suggested that taking testosterone may permanently impair an individual’s ability to conceive. However, the only study into trans men who have given birth found that prior use of testosterone did not seem to negatively impact on an individual’s ability to get pregnant. Whilst some people have conceived whilst on hormone therapy, you are much more likely to get pregnant if you stop taking testosterone (T) and you need to remain off it throughout your pregnancy. As with any changes to medication, you should discuss this with your GP.  If your periods have stopped it may take several months after you stop taking testosterone for your body to start ovulating again.

As well as stopping taking testosterone, you may also want to prepare your body for a possible pregnancy in other ways, for example by taking folic acid supplements. Click here for information on planning a pregnancy from NHS Choices (unfortunately this does assume that someone getting pregnant is a woman).

Routes to conception vary depending on whether you have a partner and, if so, who that partner is. If you have a partner who is able to produce sperm you may be able to get pregnant through sex – in fact, the study into trans men who have given birth found that a third of those pregnancies were unplanned. If you’re trying to conceive through sexual intercourse you can enhance your chances by tracking your ovulation and having sex at the point when you are most fertile.

If your partner does not produce sperm your options for getting pregnant are similar to those of cisgender women in same-sex relationships – insemination at home or using a fertility clinic.

Trans men and non-binary people can find pregnancy a challenging time. Society expects people who are pregnant to be women and the health services that support pregnant people are often planned around this assumption. Despite this, you should be treated with dignity and respect, and that includes not being misgendered. 

As well as negotiating a health service which assumes that pregnancy is purely the remit of women, you may also find that any discomfort you have about your body increases as you go through pregnancy. However, this is by no means the case for everyone. Some trans men report finding pregnancy a very challenging time, as their body takes on more gendered attributes, whilst others report feeling more comfortable in their body as it is growing a new life. Click here to watch a trans man who is pregnant talk about how he feels about the process.   

If you give birth to a child as a trans man, it’s likely that you would still be registered as the child’s ‘mother’ on the birth certificate. However, it’s unclear how your partner (if you have one) would be recorded. It’s a good idea to get specialist legal advice about how your child’s birth would be registered – click here for information about LGBT Foundation’s legal advice surgeries.

Information for trans women and other trans people who produce sperm

If you haven’t had bottom surgery (i.e. you haven’t had your penis and testicles removed) your sperm could potentially still be used to fertilise an egg. However, if you are on hormone therapy you may find this challenging. This is because oestrogen supresses sperm production and increases the risk of abnormal sperm. If you are taking oestrogen you may also find it difficult or impossible ejaculate. These changes may be permanent even if you stop taking oestrogen – for this reason it’s a good idea for trans women to think carefully about freezing some sperm (gamete storage) before starting hormone therapy.

If you want to try to get a partner pregnant using your sperm you are more likely to be successful if you stop taking oestrogen. As with any changes to medication, you should discuss this with your GP. Stopping taking oestrogen is likely to reverse or slow some of the effects of the hormone, for example you may find that the growth of facial or body hair increases.

Once you’ve been off hormone therapy for several months you may find it easier to ejaculate and your sperm count may also increase. A low sperm count has been linked to zinc deficiency and healthy sperm needs vitamin C so you may be able to improve your sperm quality by eating foods high in zinc and vitamin C or by taking supplements.

If you want to use your sperm to conceive a child you can do this either by having sex (if your partner has the ability to get pregnant) or by insemination at home or in a fertility clinic.

How your relationship to your child is recorded on the birth certificate will depend on your relationship to the child's mother. If you are legally recognised as female and in a civil partnership or married to woman who gave birth to the child you would usually be named on the birth certificate as the co-parent (this would be the same whether your partner got pregnant using your sperm or donor sperm). However, if you are not legally recognised as female and/or not married to your partner the law is less clear. It’s a good idea to get specialist legal advice about how your child’s birth would be registered – click here for information about LGBT Foundation’s legal advice surgeries.

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Trans* - Trans is an umbrella and inclusive term used to describe the whole range of people whose own gender identity and/or gender expression differs in some way from the gender assumptions made about them at birth and from the consequent biological sex assigned to them. This applies not only to those who identify as transgender or intersex but to anyone who feels that the gender assigned to them at birth incompletely or does not at all describe their own innate gender identity.