Can You Get Pregnant While On HRT?

Transitioning and fertility have a complex relationship. For individuals who wish to transition, it is imperative that they understand the effects of this transition on their ability to bear children or produce sperm. In general, taking hormone replacement therapy (HRT) is not compatible with getting pregnant. However, there are ways that can help transgender individuals realize their dream of birthing their biological children and enjoy parenthood.  

Can a Trans Man get Pregnant while on HRT?

Testosterone is not a method of birth control. It is very unlikely but possible for individuals assigned female at birth (AFAB) – who have been taking testosterone for some time and have stopped getting periods – to become pregnant. However, it is imperative that you discontinue taking your hormones for the duration of the pregnancy if you become pregnant while taking testosterone and intend to carry the pregnancy to term.

The developing fetus may suffer some harm due to the side effects from testosterone. Testosterone is teratogenic (meaning it can cause birth defects) to a fetus, as it can cross the placental barrier.

While testosterone may make it more difficult for ovulation to occur, it does not remove the chance of getting pregnant. While using testosterone, transgender males have still been known to become pregnant. So, if you continue to have intercourse with someone who can conceive, you should always use birth control to avoid an unintended pregnancy. Any kind of contraception, including the many available alternatives that do not contain estrogen, and others that contain no hormones at all, is permissible for transgender men.

An individual on HRT should see a doctor if they believe they may be pregnant or if a pregnancy test comes back positive while taking testosterone. This is because the fetus could be at risk from the deleterious effects of testosterone. If they choose to become pregnant, they must stop taking testosterone therapy and wait until their doctor gives the all-clear to start trying.

It is important to understand that testosterone does not make an individual infertile. The makeup of the ovaries is altered by testosterone, according to some research, giving them a polycystic ovarian syndrome-like condition (an issue in cisgender women commonly associated with infertility). This might lessen the likelihood of getting pregnant, at most. However, other research has shown that the ovarian structure does not significantly alter after a year of testosterone use, and follicles—the areas of the ovary where eggs grow—continue to produce.

When one is on testosterone as a prescription hormone, it could partially or completely restrict the development and release of eggs, which in turn lowers the individual’s fertility capacity. There is a paucity of data, as there is for so many other aspects of transgender health care.

While still on testosterone, trans males can still become pregnant. The chances of pregnancy remain even if testosterone use significantly lowers the likelihood of pregnancy. When having sex with a partner, where pregnancy might occur if you have not had your uterus or ovaries removed and you don’t want to become pregnant, you should use contraception. It’s also critical to know that testosterone may harm a developing fetus. At this point, it is advised to suspend the doses of testosterone until you have decided what to do next. Naturally, a circumstance like this can exacerbate any unhappy feelings. One should seek assistance and counseling right away, to deal with this circumstance in the right way.

Can a Trans Woman get Pregnant while on HRT?

In transwomen who are on estrogen therapy, the natural levels of testosterone are greatly reduced, leading to the suppression of spermatogenesis (sperm production). There are conflicting results of studies on how exogenous hormone therapy impacts the fertility of trans women. In some cases, there is a complete cessation of sperm formation, whereas in some cases, fertility was preserved, making it easy for sperm to be removed and used to create embryos through IVF (in vitro fertilization).

It is advisable to speak to your physician about your fertility status and get a fertility test done to find out your chances of producing sperm that can be used for achieving pregnancy.  

Preserving Fertility before HRT

Many trans individuals decline the chance to preserve their fertility. The causes of this are sometimes complicated, but they may include the following: 

• a natural desire to avoid having children;
• drawn-out and uncomfortable procedures for collecting and storing gametes;
• a lack of enough research, resources, and support in this area;
• a lack of support from the medical community;
• problems with funding; and
• financial, moral, and politico-legal issues.

When an individual is transitioning, fertility might not be at the top of their mind, and understandably so. Having children and starting a family might not seem like the most important thing for people who are trying to make their way out of the constant existential gender dysphoria.  However, in the future, having a biological kid sometimes becomes vital for certain transfeminine people. People’s objectives can alter depending both on their future partners and their current situation.

• Sperm Freezing before HRT (in transgender women)

Freezing sperm (sperm cryopreservation) before starting the medical transition will yield the greatest results. As soon as they reach puberty and produce a semen sample, trans women and girls can start thinking about sperm preservation possibilities (usually at age 12 or 13).

One still has choices if they have begun HRT without first protecting their fertility. A semen analysis may be an excellent place to start to see if your hormone therapy has affected your fertility. If it has, you can stop taking gender-affirming hormone therapy for three to five months to give spermatogenesis time to restart and the quality of your sperm to improve. A semen analysis is a useful starting point for the process of preserving fertility

The critical thing to remember in this situation is that you must access sperm banking (freezing your sperm) before taking medications. Just one month after beginning their hormone treatment, some patients will have no sperm in the sample of ejaculated semen or the piece of testicular tissue.

• Gamete Freezing in Trans Men before HRT

It is unknown how long-term exogenous testosterone therapy affects ovarian function. Amenorrhea and anovulatory status are frequently side effects of testosterone therapy. When testosterone medication is stopped, this can be reversible, and transmen who received prolonged testosterone therapy have reported getting pregnant.

Alternatives for transgender men to preserve their fertility beforehand are:

• Oocyte cryopreservation,
• embryo cryopreservation, and
• ovarian tissue cryopreservation.

Oocytes or embryos that have been frozen and thawed can subsequently be utilized to start pregnancy in the patient’s uterus, in a female partner, or in a gestational carrier.

Although there is a shortage of reliable data, transgender men who have begun the transition have been able to stop using testosterone and have sperm or embryos inseminated or transferred through IVF to their uterus, their partner’s, or a gestational carrier’s uterus.

• Fertility Preservation in Children and Adolescents

It is advised that before beginning pubertal suppression and therapy with gender-affirming hormones or HRT, transgender children and adolescents, as well as their guardians, be informed and counseled about possibilities for fertility preservation. Sperm, oocyte, and embryo cryopreservation are possibilities for fertility preservation in children who have begun natal puberty.

Parting Thoughts

The path to gender transitioning is not always straightforward or even feasible for everyone. The civil rights of transgender persons and the stigma and prejudice vary widely around the world. Regrettably, the topic of trans reproductive rights continues to be heavily debated on both the sociological and political fronts. There is still a dearth of awareness about trans pregnancy among the medical establishment and in society at large, even in places where trans individuals have legal protection (such as through anti-discrimination laws) and relatively simple processes to have their gender legally recognized.

At Reproductive Health & Wellness Center, a premier fertility clinic in Orange County, CA, we are proud supporters of LGBTQ families.  We also understand that same-sex and transgender couples/individuals have unique fertility needs, and we offer a wide array of reproductive options and fertility treatments.

We are honored to help all patients achieve their dreams of parenthood and we will always be proud supporters of the LGBTQ community. Because we understand that transitioning is a thrilling route to self-discovery and finally identifying with one’s orientation as one perceives it to be. AT RHWC, we invite you to schedule a consultation to explore your opportunities of achieving pregnancy and bringing the joys of parenthood to your lives.