Fertility options for trans and non-binary people

If you might want biological children one day, it helps to know your options before starting hormone therapy or having surgery. The HFEA, the UK fertility regulator, says it may be a source of regret to have treatment without preserving fertility and later find it is harder to have a biological family. Thinking it through now helps you decide.

• Hormone therapy suppresses fertility and over time can lead to a complete loss of it. Fertility may return after stopping, but this is not guaranteed, and the longer you take hormones, the more likely the effects are to be permanent.
• If you have been through puberty you may be able to freeze eggs or sperm. Egg freezing involves fertility drugs and a procedure under sedation. The HFEA says it is mostly very safe, but there is a risk of ovarian hyperstimulation, which can need hospital treatment.
• Genital surgery such as removal of the womb, ovaries or testes means you cannot have biological children without stored eggs, sperm or embryos, or a surrogate.
• Stopping hormones usually lets ovulation or sperm production restart over a few months, but a fertility specialist can advise on your own situation.
• Since 1 July 2022 you can store eggs, sperm or embryos for up to 55 years, as long as you renew your consent every 10 years.
• NHS funding depends on where you live. In England your local integrated care board decides, so ask your GP first.

Whatever you decide, it is your decision. A GP can refer you to a fertility specialist, and you can ask your gender service about preserving fertility. If you do get pregnant, the NHS says it can trigger feelings of gender dysphoria, and the LGBT+ helpline Switchboard can talk it through.