Desire in Trans Youth to Preserve Fertility
As transgender healthcare continues to advance and become more accessible, people are able to express their identity much earlier than they could in the past. This, along with increased social acceptance, has created large growth in the numbers of youth coming out as transgender. A recent study found that nearly 9% of youth in one urban school district identified in a way different from their assigned sex at birth.
Processes for how to address the medical needs of transgender youth continue to evolve. Because the onset of puberty can cause severe distress for many transgender adolescents, there are now options that allow youth and their families to decide to hit pause on natal puberty, giving the youth more time to decide if hormonal transition is right for them. These options are commonly referred to as “puberty blockers.” Puberty blockers (and gender-affirming hormone treatment) can impact fertility, and counseling on fertility preservation is considered a necessary part of care for trans youth.
However, most transgender people received little or no formal information about their fertility in general, and fertility preservation is still rarely discussed. And the counseling that is offered is often not effective: between 2-4% of transgender youth ever choose to preserve their fertility, even when counseled on the subject. It’s also possible that even the BEST counseling simply won’t be successful: a study conducted published in 2016 by Nahata et al. found that over 65% of transgender youth did not plan to have children who are biologically theirs. Of those who declined to preserve their fertility, additional reasons cited include the financial burden, fear of physical body changes, and fear of misgendering or dysphoria from the process itself. Researchers theorize that the number of youth choosing to preserve reproductive cells may continue to rise as cultural competency of staff continues to improve, insurance becomes more encompassing of trans healthcare needs, and access to proper counseling is achieved.
Fertility preservation options for trans or nonbinary youth depend on the level of puberty that their body has already undergone. The scales for puberty development are called the Tanner scale. If they have not yet begun puberty, they will need to undergo a more experimental process that will collect tissue samples with the hope that at some point in the future, those tissue cells can be matured to create gametes (sperm or egg cells). In order to collect and preserve actual egg or sperm cells, which is a highly successful process that has resulted in thousands of successful births worldwide, an individual will need to cease their puberty blockers and go through a certain part of natal puberty.
This means that if a young person who was assigned female at birth begins a regimen of puberty blockers before the onset of puberty, they would need to take a break from that process in order for their body to undergo hormonal changes enough to begin menstruation first. Similarly, for a young person assigned male at birth who is on puberty blockers, they will need to stop taking their blockers in order to achieve a certain level on the Tanner scale. Otherwise, it will be impossible to collect sperm cells.
The process of beginning puberty, even temporarily, can be an intimidating and even frightening prospect; that’s why puberty blockers exist! So this process of allowing puberty to initiate can be a deterrent for some people. Talking to your endocrinologist and fertility specialist can be beneficial because there may be options for medication that help keep secondary sexual characteristics at bay through cell retrieval.
For young people who have already started puberty, or who stop their hormone blockers in order to engage in fertility preservation, cell retrieval can be relatively straightforward— or it may be complicated, depending on the situation.
For those who produce sperm, there are many options for gathering sperm cells, all of which can be explored with a reproductive endocrinologist or urologist. Even for young people who have high levels of dysphoria, there are ever-increasingly diverse ways of collecting the gametes needed for preservation.
For those who produce ova, the process is the same as it is for an individual going through the first process of in vitro fertilization (IVF). The process is called “egg harvesting and cryopreservation,” and it is quite medically involved but extremely effective at gathering enough eggs to achieve a successful pregnancy down the line. The first injection medication is taken to cause the body to grow multiple eggs simultaneously, then another injection medication is used to release them from the ovary. The eggs are then harvested from inside the body while under anesthesia. While uncomfortable at times, the overall process is relatively painless and most people have no recollection of the harvesting procedure itself. To hear more, visit our video gallery where we have an interview with a trans youth who has completed an egg harvesting cycle.
If you are a young person or the caregiver to a young person contemplating hormone therapy, know that there are options out there for you to expand your family using your own reproductive cells. Whatever your family goals are, Trans Fertility Co. will be available as an ongoing resource for resources and support. You can always reach out to us with questions, or if you would like to share your story, you can email us at adennis@collaborate.consulting.
