Transgender Youth & Fertility: How and Why We Should Plan for the Future

By Trystan Reese, Director of Family Formation

Here at Family Equality, we believe that everyone should be able to build a happy, thriving family on their own terms. But what does that mission mean for transgender youth? 

Since no one exactly knows what fertility possibilities might be like for transgender youth who didn’t have a natal puberty (a puberty their body would have gone through without hormonal intervention), the best advice we can give is for trans youth to go through some kind of fertility preservation, if it’s possible for them (and their families!) financially and emotionally. Very successful procedures exist for any young person whose body has reached enough adolescent maturity to produce reproductive tissue, yet the vast majority of trans youth do not end up preserving their fertility. A 2017 study tells us more about why. 

A team of researchers from across the U.S. looked at medical records from 72 transgender youth who had received counseling on fertility preservation options. Of those 72 youth, only two chose to pursue fertility preservation. Of those who didn’t choose to preserve their fertility, 45% stated that they planned to adopt and 21% said they never wanted to have children. 8.2% found the process too costly, and only 1.4% stated that they didn’t want to delay their transition in order to go through the process. 

It’s important to note that trans adults overwhelmingly say they wish they had preserved their fertility if it had been offered as an option (51% of trans women and 37.5% of trans men). So we simply don’t know enough yet about whether these youth will have regrets about their decision not to preserve their fertility, but the authors of this study draw parallels to the millions of adults who experience infertility and identify that struggles with fertility cause multiple negative psychosocial impacts. Until this study, there was a general understanding that fertility preservation rates were low because trans patients weren’t being adequately counseled on the subject. But this new research illuminates a different issue– even with counseling, transgender youth still don’t take action to preserve their fertility. 

And perhaps this is not actually a problem. Perhaps these youth are correct in assuming that they plan to adopt or won’t ultimately want to become parents. But there is quite a bit of research on survivors of childhood cancer, and those who had lost their fertility as a result of cancer treatment say over and over again– they experience distress related to their inability to have biological children. Additionally, surveys of transgender adults have shown that many trans adults have regrets about their transition-related fertility loss. 

So it’s worth thinking about how adults supporting trans youth can have constructive, developmentally-appropriate conversations around family planning, fertility, and possible future changes in parenting desires.