Fertility Preservation in the Trans Community

At work I have a bunch of different searches set up to email myself different journal articles related to queer bioethics, LGBT research ethics, transgender stuff, etc. Lately I’ve come across a number of different articles on the ethics of fertility preservation in the trans community (particularly with any type of body modification)

I’m probably less interested in the ethical debates and more interested in the implementation.  Things like providers having conversations with their trans patients/clients and establishing clinical guidelines and protocols for these discussions.  It’s nice to see that some places include fertility, like UCSF’s Center of Excellence for Trans Health’s “Primary Care Protocol For Trans Health”.    

Thinking back to the time (about 7 years ago now) when I started taking testosterone no physical or mental health providers ever discussed fertility issues with me. Granted, I may laughed in their face.  I was around 25 or 26 at the time.  I wasn’t ready to think about kids.  I was totally absorbed with surviving day-to-day and jumping through hoops so I could finally begin my transition and feel more comfortable in my body.    

 Things get even more important/interesting/complicated as youth begin to transition at earlier ages.  I know there is quite a bit written about having discussions about fertility in the oncology field, with teenagers who have cancer, but I haven’t found much of anything about teens and transition and fertility.   

Some of the research I currently work on is related to patient education and risk communication related. Specifically we look at improving ways of presenting risks and benefits of different treatments to help patients make better decisions. I often think about the decision to begin hormone therapy for trans folks….but I wonder how effective even the best designed health education materials could really be.  I’m sure everyone has their own unique experiences but personally my drive for self-actualization was so strong that I paid little attention to the risks (or just minimized them). 

In my case I think I would have responded similarly if a provider would have tried to discuss fertility with me back then, yet now I really wish they would have.

3 thoughts on “Fertility Preservation in the Trans Community

  1. Interesting topic. My last job was an an LGBT health clinic and I did a lot of counseling with young people wanting to start hormone therapy. We ALWAYS discussed fertility issues with them, but as you say, it can be a hard topic for a young person to wrap their head around (especially the younger they are). But I agree it’s so important to at least have the conversation.

  2. For what it’s worth, I’m about to start T and fertility concerns have been discussed with me, so it’s possible things are changing. I’m kind of glad that’s one of the worries I actually don’t have heading in though. We have our kids. We’re very much done, and that decision was made thoroughly by both of us prior to transition being on the table as a real possibility. That said, finding good concrete information on some of the other risks feels harder to me. My clinic has a relatively detailed informed consent form, though I wish it had citations. Lord knows I’ve read a million detailed lists (but decidedly lacking in actual stats or odds ratios) from various sources. But when I dig in myself at pubmed the actual results out there seem somehow both skimpy and incomplete, and yet still overwhelming. I’m a scientist. I know how to read this stuff. But somehow parsing risk/benefit when it comes to this, for myself in the here and now, feels impossible to do in a principled way.

  3. This is interesting to me, and I’m also glad this is becoming part of the standard of care. It means that practitioners and counselors are thinking about transitioning folks as regular folks in a crucial way–that they might be not just interested in being parents but worthy and capable of being parents. It really indicates the demise of much of the stigma of medical management, in my opinion.

    But I think there’s issues related to storing eggs vs. storing semen. I think if someone wants to go on T, and they are thinking about banking eggs for later, this involves an invasive procedure and a hormone regimen that can be a bit dangerous anyway, but also would involve going hormonally in the wrong direction. Obviously this isn’t the only way to go, but could be for some people (say, aging and entering a period of reproductive decline anyway). There are class issues too, since there are ongoing fees for storing the gametes.

    I also might have laughed. I was not sure how or if children would come into my life in my 20s, and might have been willing to chuck it to move forward with my life even if presented with this counseling.

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