Options for Trans Women & Trans Men
Pre- or non-operative trans women and trans men are able to biologically conceive and, in the case of trans men, carry pregnancies. However, while there are medical steps to make this a possibility, it is equally important to consider the psychological aspects that accompany the necessary reversals in gender-oriented hormones.
In order to stimulate sperm production or gonadal function in trans women, we must withdraw estrogen support and allow for an increase in testosterone levels. This process, which is called re-androgenization, can unfortunately take six to 12 months, and while it is often successful, there is a possibility that sperm production will not be achieved. During that time, trans women can expect a reversal of their more feminized features and an increase in masculine features such as facial hair and a deeper voice.
Once a sperm sample has been successfully collected, both the count and motility will typically be low. As such, artificial insemination is usually not an option, and we must proceed to in vitro fertilization (IVF), where as few as several sperm can be used successfully.
The process for trans men is somewhat easier in terms of hormonal changes. While they must come off their androgen support, such as testosterone, it is not necessary to wait for the full return of ovarian function to stimulate follicular maturity. Once the effects of testosterone replacement have been suppressed, which usually takes as little as several months, trans men are put on birth control pills to control the hormonal environment at the level of the ovary. From there, they are given the same hormones given to cisgender women undergoing IVF.
Again, since the hormonal changes necessary to achieve conception also require trans men and trans women to step back into a gender role with which they do not identify, it is very important for them to have a strong psychological support system throughout the process.