What fertility treatments are available for LGBTQ patients?

By Teresa M. Erb, M.D.

What does transgender mean?

Most people are assigned a sex at birth (boy vs. girl) based on their external genitalia.  For some people, that “boy” or “girl” label may not feel right.  For example, someone born and labeled female may feel that they are really a male. Conversely, someone born and labeled male may feel that they are really a female. Transgender is a term used to describe people who may feel this way. 

Others may feel that they belong to neither gender or to both genders. Terms used to describe this setting may include “gender fluid,”  “gender queer,” “gender neutral,” and “gender nonconforming.”

Members of the transgender or queer community may decide to change how they dress, change their name and change their preferred pronouns. Some may even choose to take hormones or to have surgery so that their bodies more closely match their gender identity. Others do not. There is no “correct” way to be a transgender person.

Do I need permission for a medical transition?

In most places in the United States, you will need permission from your parent or guardian to do a hormonal or surgical transition before you are 18 years old. You also will need to talk with a mental health professional and get a letter of support before starting treatment. This may involve multiple counseling sessions.

How do hormonal treatments work?

Hormonal treatments are usually managed by a pediatric or medical endocrinologist.  

One way that hormones can be used for a medical transition is to block or delay puberty.  These medications can stop menstrual periods, breast growth, facial hair growth and deepening of the voice. You may need to wait until you have started the early stages of puberty before taking puberty blockers. Most effects of puberty blockers are reversible.  

Another way that hormones can be used is to help you look or sound more masculine or feminine. This also may be called gender-affirming hormone therapy. Depending on the treatment, these medications can help you develop desired characteristics, such as: deepening your voice, growing facial hair, developing breasts, changing your body shape.  Most of these changes cannot be reversed.

What fertility treatments are available for transgender patients?

Some kinds of hormone treatments may make it harder for you to have a baby in the future. Some kinds of surgery may make it impossible. Talk about this with your doctor before you have treatment.  Prior to initiating any hormonal or surgical treatment, it is advisable to meet with a reproductive endocrinologist to review future reproductive treatment options which may include:

• Freezing your eggs or sperm 
• Intrauterine Insemination
• In Vitro Fertilization
• Freezing Embryo(s) 
• Using donated eggs or donated sperm to achieve a family
• Using the help of a gestational carrier to help you achieve a family
• Adoption

If you have questions about your gender identity:

If you have questions about your gender identity it may be helpful to talk with your parents, a teacher, counselor, doctor, or other health care professional. It’s a good idea to ask about what can be kept private before you talk with an adult.

There are websites and hotlines where you can be anonymous if you need information. These websites also can help you educate your parents, family, and friends about the transgender community. 

Resources

• Centerlink
  (954) 765-6024
  www.lgbtcenters.org
  Directory of community centers for LGBT people.
• Transgender Care Listings
  www.transcaresite.org
  Directory of trans-friendly health care professionals.
• Trans Youth Equality Foundation
  www.transyouthequality.org
  Resources for transgender teens and young adults.
• Campus Pride
  www.campuspride.org
  Resources for LGBTQ college students.
• PFLAG
  (202) 467-8180
  www.pflag.org
  Network of communities for LGBTQ people, parents, and friends.
• Gender Spectrum
  510-788-4412
  www.genderspectrum.org
  Organization that supports gender expansive children, teens, and their families.

Hotlines

• Trevor Lifeline
  Toll-free: 866-4-U-TREVOR (866-488-7386)
  Hours: 7 days a week, 24 hours a day
  www.thetrevorproject.org
  Confidential suicide and crisis counseling for LGBTQ teens and young adults. Text and instant messaging options are
  available on the website.
• Trans Lifeline
  Toll-free: 877-565-8860
  Hours: 7 am–1 am PST / 9 am–3 am CST / 10 am–4 am EST
  www.translifeline.org
  Peer support hotline that is run by and for trans people.
• LGBT National Youth Talkline
  800-246-PRIDE (800-246-7743)
  Hours: Monday–Friday 1 pm–9 pm PST / 4 pm–12 am EST, Saturday 9 am–2 pm PST / 12 pm–5 pm EST
  [email protected]
  www.glbthotline.org/youth-talkline.html
  Peer support and resources for LGBTQ teens and young adults.