gendr
Step 6 of 8Fertility

Fertility and reproductive choices.

An emotionally weighty topic, addressed before any medical step is finalised, because that's when most choices are still open.

Team talk

A conversation worth having early.

Whether or not you ever want to be a genetic parent, this is a one-time-window choice. Once hormones have been started for long enough, some options may no longer be available, or only available with extra steps. We place this step before any final hormone decision for that reason.

Option talk

What hormones can do to fertility.

Both feminising and masculinising hormone therapy can affect fertility. The extent and reversibility vary between people and aren't always predictable. Stopping hormones doesn't reliably restore fertility, especially after longer use.

If the possibility of genetic parenthood matters to you at all, even slightly, even hypothetically, it is worth raising with your clinician before starting hormones.

Option talk

Preservation options.

If you produce sperm

Sperm banking

A short, non-invasive process: a small number of samples are produced, analysed and frozen. They can be stored for many years and used in future fertility treatment (your own, a partner's, or a surrogate's).

Best done before starting feminising hormones.

If you produce eggs

Egg or embryo freezing

A more involved process: hormone stimulation over ~2 weeks, then a day-case procedure to retrieve eggs. Eggs alone, or fertilised embryos (with a partner's or donor's sperm), can be frozen.

Usually done before starting testosterone, though pausing testosterone for retrieval is sometimes possible.

Other paths

Adoption, fostering, donor conception

Genetic parenthood is one route to family. Adoption and fostering are real and supported routes for trans people. Donor conception means using donor sperm or eggs (or both), a route many families take.

A real option

Not preserving

Many people decide they don't want genetic parenthood and don't preserve. That's a valid, common choice. Reasons vary, values, cost, dysphoria with the process, certainty.

The point is that it should be your choice, made with information, rather than something that happens by default.

An honest note on NHS funding. NHS funding of fertility preservation for trans patients is currently a postcode lottery: it depends on your Integrated Care Board (ICB). Some areas fund collection and storage fully; others fund neither; many sit in between. Your GIC or fertility clinic can tell you the local position. The Levy Review (2025) recommended equitable national access, but this is not yet in place.

Your words

How does the possibility of genetic parenthood sit with you today?

Decision talk