Published by Anja Health on
August 30, 2022
— Updated on
August 30, 2022
Testosterone can impact fertility in transgender males. However, testosterone delivered to the body through any route (injection, patch, etc.) does not necessarily make an individual infertile. Suppose a transgender male has unprotected sex with someone with sperm. In that case, it is possible to get pregnant, even while on testosterone. The chances of pregnancy may be reduced, but the potential still exists. If pregnancy is unwanted, you should be sure to use a reliable form of birth control.
When a transgender male wishes to utilize their eggs for a child and has already begun testosterone therapy, the testosterone will need to be stopped for a few months, if not more. Suppose an individual has been on testosterone hormone therapy for an extended period. In that case, their body may no longer be releasing eggs. Specialty methods may need to be utilized, such as fertility medications and/or procedures such as in-vitro fertilization.
The medical research for transgender patients is currently limited. The good news is that more research is happening for transgender patients, including in the reproductive medicine space.
As more transgender people consider having biological children, it's essential to be well informed of the risks and benefits. Ideally, someone considering hormonal treatment with testosterone should store eggs before beginning testosterone for various mental and physical reasons. However, there is still a chance of pregnancy even if a trans person tries to use their eggs after starting testosterone therapy.
A common misconception is that testosterone therapy will cause infertility and that the eggs cannot be utilized. Research finds this misconception untrue, yet many factors still exist to consider with fertility after testosterone therapy.
Testosterone therapy brings a risk to fertility, even though studies show promise of successful egg retrieval in transgender males. Testosterone often stops ovulation from occurring altogether, so without ovulation, it means no pregnancy.
The impact of testosterone on egg fertility is still a bit unknown as studies are limited; however, it is known that testosterone currently needs to be stopped before considering harvesting eggs for a procedure such as IVF. After stopping testosterone, many factors impact the return of ovulation; it takes about three to six months for ovulation and regular periods to return.
Using testosterone therapy impacts ovulation and demonstrates uterine changes such as uterine atrophy. Due to the low number of studies, there is still more to be discovered in this area. What has been found is that testosterone typically causes menses to stop altogether. Stoppage of menses is not indicative that ovulation has stopped, so even on testosterone with no periods, a trans man can become pregnant with unprotected sex involving semen.
Transgender males on testosterone therapy may also have occasional breakthrough periods and ovulation. Although the chance of pregnancy in any given month is low, there is still an opportunity.
It is currently unknown how many transgender males in the United States have opted to store their eggs before hormonal therapy. Some transgender men may opt not to begin hormone therapy, and ovulation will remain intact in these cases.
Individuals beginning testosterone must realize that should they choose to have a biological child later, stopping testosterone will be required. While this will make egg retrieval easier and improve the chances of success, the transgender male and their partner, if any, should discuss and consider the potential for body dysphoria to show due to physical changes while off testosterone.
A female-to-male individual can get pregnant if they have all the parts necessary for a viable pregnancy: uterus, ovaries, and womb. Some individuals opt to have some or all of these removed, so, therefore, cannot carry a successful pregnancy.
In people who still have a uterus and ovaries, with or without testosterone therapy, there is an ability to get pregnant. A transgender male individual may face an accidental pregnancy while on testosterone with no regular periods, as ovulation may still occur.
Ovulation will restart approximately 3-6 months after stopping testosterone. However, it may take longer than that period for a viable pregnancy to occur. Other factors, such as the presence of other disease states, overall health and wellness of the individual, and more, impact the ability for a natural pregnancy—one without additional medications or procedures. An FTM individual may also be able to get pregnant via a method such as IUI or IVF.
More research is needed on testosterone's impact on pregnancy in transgender males. Still, the current recommendation is to stop testosterone therapy before pregnancy.
Therefore, transgender men can opt to freeze eggs or embryos, or even ovarian tissue before beginning testosterone therapy. If testosterone therapy has already started, testosterone should be stopped before the ovaries are stimulated to release eggs.
Transgender men have options for pursuing a pregnancy. For female-to-male patients who have frozen eggs or embryos, gestational surrogacy is an option. Trans men without a hysterectomy may also consider carrying a pregnancy themselves. Embryo or egg donation is also available.
We recommend you talk to your health care provider or fertility specialist to determine the best approach for your family.
Transgender children and teens and their guardians should discuss options for fertility preservation before starting pubertal blockers (prescription medications that temporarily suppress puberty).
Fertility preservation options for children and teens who have already started pubertal blockers include sperm, oocyte, and embryo cryopreservation.
Prolonged use of pubertal blockers using gonadotropin-releasing hormone (GnRH) analogs is usually reversible. Puberty should resume upon stopping, though many people who undergo pubertal suppression go on to begin gender-affirming hormone therapy without undergoing natal puberty.
It is never too early to begin planning if a family is in your future. Female-to-male people who want to have a child should research and discuss with their healthcare provider what will work best for them and their families. Regardless of whether to carry a pregnancy themselves or use a surrogate, Anja Health is here to keep your family healthy and happy in the coming years.
Anja Health can safely store the potentially life-saving stem cells found in the umbilical cord and placenta. Getting a Stem Cell Safe is simple, and you can trust that the future of your child's health is in excellent hands.