Do Laws Matter?

At a time of truly unprecedented attacks on our communities across the US, it’s a good time to consider whether laws and policies have real-world impacts on the daily lives of trans Americans. At times, it can seem like laws are symbolic, rather than practical, in their effects. But the data shows that in the world of trans fertility, laws can make a HUGE difference.

Let’s look at California as an example. In 2020, Senate Bill 600 passed, requiring California-based insurers to cover fertility preservation that is considered “medically necessary.” The most commonly discussed examples of this necessity were cases of cancer (called oncofertility cases), where chemotherapy was likely to render a patient sterile. However, once passed, the law was interpreted as applying to trans folks as well. The logic is sound: if HRT is considered medically necessary for transgender people who wish to transition hormonally, and that HRT is likely to impact future fertility, then it stands to reason that fertility preservation should be considered “medically necessary.”

But does the passage of a law like this actually increase access and utilization of fertility preservation?

The data says, “yes.”

Natasha Raj-Derouin, MD, MS, a resident with Kaiser Permanente Los Angeles Medical Center, shared this data during a presentation at the ASRM Scientific Congress & Expo. She shared, “Our organization saw significant uptick in the number of transgender patients seeking fertility preservation.

“It is worth noting that prior to 2020, when the Senate bill was passed, there were only 24 fertility preservation referrals placed vs. 411 referrals after the bill passed,” Raj-Derouin said.

And there are many downstream impacts of laws like this, above and beyond increasing access and affordability. With the addition of this many more patients engaging in fertility preservation, we now have hundreds more data points on the experiences and outcomes of these processes. In fact, the additional data available to Dr. Raj-Derouin and her colleagues at KPLMC resulted in another study finding that testosterone use has no negative impact on fertility outcomes.

At Trans Fertility Co., we laud and support those doing the sometimes thankless work of advocacy and policy change to help create more opportunities for reproductive access and justice everywhere. Thanks for all you do.