Affirming Fertility Care: Supporting Transgender and Nonbinary Individuals on their Family-Building Journey
Today marks the end of Transgender Awareness Week, which ran from November 13-19. This week is about increasing understanding of transgender and nonbinary people and the issues they face. Some of those issues are the unique challenges they face when building a family. Fertility care is an essential, comprehensive part of health care, yet it is often overlooked or under-discussed as it relates to the transgender and nonbinary community. In this post, I aim to raise awareness, share options, and advocate for inclusive and affirming reproductive health care.
Fertility preservation for transgender and nonbinary individuals matters because hormone therapy and gender-affirming surgeries can affect fertility potential. Folks who will be using hormone replacement therapy or undergoing surgery should automatically be counseled about fertility preservation. Early, proactive fertility counseling can empower individuals to make choices about their reproductive futures that are best for them, while remaining true to who they are. Unfortunately, access to this information and care remains inequitable. There needs to be more providers who are trained in and committed to providing high-quality trans-affirming fertility care.
Some of the available family-building options for the transgender and nonbinary community include the following:
Egg or sperm freezing → before starting hormone therapy or surgery
Embryo freezing → for folks with partners or using donor gametes
Third-party reproduction → the use of a gestational carrier, donor eggs, or donor sperm (or all three!)
Adoption and fostering → a valid, loving pathway to building a family
There are many barriers to access to information. Cost and insurance coverage gaps are real, with many insurance providers not covering the cost of IVF or fertility preservation without a traditional infertility diagnosis. Many in the community also face discrimination or lack of knowledge from providers who are not adequately trained in competent, transgender-affirming care. There can also be the emotional impact of body dysphoria during treatment, leading to feelings of distress during an already overwhelming and complex process. Providers must be mindful of using trauma-informed, inclusive language and creating a caring environment that treats people with dignity and respect.
Clinics, employers, and healthcare institutions need to include trans fertility education in their health programs and provide well-informed resources. At Full Bloom Fertility, my mission is to bring inclusive, reproductive-justice-centered education to organizations, patients, and communities so that everyone has access to the information they deserve to make well-informed decisions about their bodies and reproductive futures.
