Transgender Men and Nonbinary People: Pregnancy, Fertility, and Misconceptions
In 2008, Thomas Beatie made headlines when he went on the Oprah Winfrey show and announced that he was pregnant. At the time, no one had heard of a pregnant man before. The world was baffled, many looked at the story with confusion, but upon revealing that Thomas was transgender and happily and healthily building his family biologically, a new horizon dawned as acceptance and awareness around transgender parents now had foundations to grow into a brighter future for LGBTQ families.
In the early 2000s, awareness of LGBTQ issues was not what it is today, and the piece featuring him was like nothing that had ever been broadcasted. As the show detailed how Thomas got pregnant, outlining this journey through his transition, showing his ultrasound and him speaking with his wife about how badly they wanted a child, the idea seemed less foreign to people.
Thomas went on to have two more children, and has a happy family with three little ones to share his life with. His pregnancy was just like any other pregnancy, and as he said on the show “I’m a person and I have the right to a biological child” his words became the first public step toward a more aware and open culture surrounding transgender pregnancy. They helped show the world that families are centered around a parent wanting to love a child unconditionally, instead of being centered around traditional gender roles.
Currently, there is very little data showing how many transgender and nonbinary people give birth in the US. When someone comes in to give birth, the system will track them as female and give no alternative option. It is clear that the transgender community is growing as more people feeling comfortable to come out and be themselves. There are now 1.4 million US adults who identify as double the estimates of the data that was published ten years ago. In the Australian medical industry sex and gender has started to be recorded. Since 2013, officials have been tracking this information, and in 2014 found that 54 transgender men gave birth in the country. But progress is not always quick, and even as society is becoming more aware and educated about this topic, we still have a long way to go before transgender or nonbinary people get the proper equal care that a cisgendered pregnant woman would receive.
The misconceptions and false information surrounding trans and nonbinary conception are often prevalent in the fertility community. Openness about transgender issues has been growing over the years, but the medical industry still has a lot of catching up to do. Many doctors or nurses still are not used to dealing with transgender patients. And transgender parents are often thrown into difficult situations where they receive improper care, advice, or are misgendered by staff.
Our aim in this blog is to work toward eliminating misconceptions around transgender and nonbinary pregnancy by outlining the facts, talking about what’s really going on with transgender pregnancy, and giving you all the options you need to start your family in the way that you feel is right.
Going into a doctors office as a transgender or nonbinary person is already something that can cause anxiety, and depending on where you live, some doctors may have never received training on care for transgender or nonbinary patients. Medical schools and residency programs are just now starting to integrate information on transgender patient care and practices into their programs.
There are also programs that aim to educate doctors and nurses who are already practicing about how to properly give care to transitioning or transitioned patients, including how to use proper pronouns, the differences in their physical bodies and symptoms they may present, and sensitivity training. Unfortunately, we are still working our way toward this being a standard in the medical industry. And when it comes to fertility, many doctors simply don’t have all the facts about transgender pregnancy.
People who have been on testosterone are often told that it has sterilized them, making them infertile or unable to have children. Many doctors have been told this, and they assume it is the case. This leads to transgender or nonbinary people feeling hopeless, like they will never have their own family and have to give up an important part of their future just to be themselves.
It’s time to be rid of this myth.
It is simply not true that a transgender person is doomed to sterility, and it is dangerous to have this kind of misconception shaping the way people take action about their futures. While some who have taken testosterone may have difficulty getting pregnant at first, it does not sterilize someone who takes it. Testosterone blocks ovulation if taken regularly, but it does not completely make it disappear, and if it is taken irregularly, one can actually get pregnant while they go through their transition.
Although it seems like testosterone would be adequate birth control, if someone who was born with a uterus is having intercourse with a male partner, contraception is still necessary, as pregnancy is still a possibility.
Transgender FTM Fertility
Once testosterone is no longer being taken, some people conceive very quickly, while others have to wait many months or even a year in order to conceive. A couple can conceive through traditional intercourse if one has the capability of producing sperm, or they can use IUI (intrauterine insemination) if their partner cannot produce sperm or if they want to use a donor. Everybody is different, and how a cycle changes as testosterone builds up is unique to each individual.
Even though testosterone may not sterilize someone, it may still be a good idea to freeze your eggs before committing to your transition. As stated before, everybody adapts differently to the changes transitioning brings. If you want a family in the future, it is prudent to be safe and make sure you have a backup plan in case fertility does become an issue. The reproductive system can be tricky, and if you know a biological child is a priority for your family, protecting your eggs while they are healthy is a way to help ensure you have the family you want down the line.
Egg Freezing is a relatively straightforward process, and we have fertility specialists, with over 10 years of helping trans people that can help give you all the information needed if you are considering this option. It is a safeguard to help protect your biological eggs and preserve them in case anything may happen to your reproductive system, and thanks to modern technology, success rates of healthy pregnancies from frozen eggs or embryos are climbing higher each day.
For patients that have a partner or sperm donor they want to use, if the traditional route of conception through intercourse is not an option or does not work, these frozen eggs can be fertilized and then implanted into the uterus through IVF. Thankfully, success rates for IVF are also climbing higher each day, and give can give people who struggle with infertility the option of having a healthy biological baby whenever they’re ready! Some people will choose to have their female partner carry their egg for them as well, this allows both parents to feel like they are involved in creating their child and go through the process together.
The idea that someone on testosterone can never have their own biological child is not only false, but it is also dangerous. It means that transgender and nonbinary people are not being properly educated on what is going on with their bodies, and the consequences can be heartbreaking.
Last year, the New England Journal of Medicine published an article describing a transgender man who arrived in the emergency room with abdominal pain. While he told the nurses he had transitioned, their conceptions of him as a man altered how they went about their course of treatment. It wasn’t until he had been in the ER for several hours that it was discovered he was pregnant. When his child was finally delivered, it was sadly stillborn. Had the doctors adjusted their care and had the knowledge about transgender health needs, they may have taken a different course of action right away. But so many people think of gender as simply “man” or “woman” and classify health issues into those categories as well. Efforts need to be taken to counteract these gender biases and give people who transition the tools and care they need to be healthy.
Gender bias and improper care can be incredibly hard for someone who is transitioning to go through, especially during times when they are sick or in need of a medical professional, putting them in an even more vulnerable position from the moment they walk into a clinic or ER. The pain stemming from improper care can cause transgender or nonbinary people to avoid seeking medical treatment for ailments or serious conditions. In 2016 the journal Medical Care reported that 30% of transgender people either delayed or did not seek out healthcare out of fear of discrimination. This can mean life or death for some, and the feeling that medical services are not available can push people toward actions that may point them in the wrong direction.
Many trans or nonbinary patients will turn online to try and find solutions to their ailments instead of going to a doctor. This further leads to misinformation and confusion among the community, often resulting in people believing things that are not true. One example is that amount of transgender men who believe that in order to transition, they need to get a hysterectomy, or else they will get uterine cancer.
The thought circulating online is that testosterone can cause uterine cancer if taken over time, and that it will be dangerous to transition without getting this intensive surgery. There is absolutely no rigorous research that supports this claim, and transgender men can indeed transition without putting themselves through this drastic surgery. Still, the idea is prevalent, and shows how difficult it is to find out the facts regarding transitioning, fertility, and what actually happens to the body when it goes through a transition.
Transitioning to a male or nonbinary identity is be difficult enough as it is, but going through pregnancy can add another level of hardship to this process. For some transgender or nonbinary people, pregnancy can reignite feelings of dysphoria, making them feel uncomfortable in their bodies and with their gender identity all over again.
Pregnancy is not permanent, and holding your child in your arms is worth every moment, but the process is hard, and getting to the endpoint can bring up a whole new battle within oneself. That’s why having a counselor or therapist through pregnancy and even for a little while after pregnancy can help get someone through the difficult moments and help them see the light at the end of the tunnel. There are services and specialists that provide wonderful care, and will work hard to make sure building a family does not have to mean sacrificing one’s mental health.
Even with counseling, for some the struggle would be too dangerous. That’s why if a transgender or nonbinary person still wants to use their eggs, but does not want to carry the child themselves, and does not have a partner who is able or willing to carry the child, surrogacy is a wonderful option that can help them build a family without putting themselves in danger. They can use their eggs, a partner’s egg or sperm, or a donor egg or sperm, all the while maintaining their safety and mental health so they can be the best parent they can be to their baby.
As we move forward and LGBTQ+ issues have a larger public platform, it is key that we make efforts to support the future of all LGBTQ+ people. We at the Reproductive Health and Wellness Center believe that everyone deserves to have the happy family they dream of. We hold firm that if someone wants a biological child, every effort should be made to help them achieve their baby, and if for some reason a biological child is not an option, we will utilize every tool we have to still give you a the family you want through donor eggs or sperm, IVF, or surrogacy. Thinking about planning a family can be a momentous task, but you are never alone. We have specialists that care deeply about giving you personalized care, and have worked closely with transgender, nonbinary, gay, lesbian, and queer patients to give them the exact specialized care they need.
LGBTQ+ Fertility Doctor in California
Our founder, Dr. Marcus Rosencrantz, is educated on the medical issues facing transgender or nonbinary patients and pregnancies, and will work with you to give you the highest standard of fertility treatments and services. We want to help you build a family, and we don’t think you should sacrifice your physical or mental health in order to do it. We want to help you be informed about your body and your journey, and believe it shouldn’t be difficult to have access to well-researched information about transitioning and pregnancy. We want you to have the future you’ve dreamed of, and will do everything we can to help you get there. To start your family planning journey, Call or text 949-516-0606 or click here to book a consultation.