Parenthood may be part of your vision for the future. But if you’re currently on testosterone, you may not be sure what’s possible when it comes to fertility.
You deserve information that affirms your identity and gives you real choices. In this guide, we’ll cover how testosterone affects fertility and provide options for next steps. We can help you find the right path that aligns with your identity, comfort and goals.
If you’d like more information, fill out our form to connect with one of our surrogacy specialists.
Can a Trans Man Get Pregnant While on Testosterone? What to Know
Technically, yes, a trans man getting pregnant while on testosterone is possible, but unlikely. Testosterone generally suppresses ovulation and may affect an embryo’s ability to implant in your uterus.
Because of this, the chances of a trans man on hormones getting pregnant are very low. However, with fertility preservation and temporarily stopping hormones, pregnancy may be possible.
Does Fertility Change in Trans People With Hormone Treatment?
Yes, testosterone impacts both the consistency and quality of egg production. Over time, it suppresses ovulation and usually stops periods altogether.
The effect depends on how long you’ve been on testosterone, your age and your reproductive health.
Because egg quality naturally declines with age, and testosterone can add complexity, early planning matters.
In addition to impacting egg production, testosterone may also affect the uterine lining, which can make it more difficult for an embryo to implant successfully.
Can a Trans Man Do IVF? How it Works At Different Stages of HRT
Yes, IVF is a viable option for many trans men, but it involves important considerations depending on where you are in your hormone journey.
If You Are Pre-HRT
If you have not yet started hormone therapy, it is typically recommended to freeze your eggs before beginning testosterone. This helps preserve your fertility at its current baseline.
If you decide to pursue pregnancy later, you will still need to pause testosterone during the embryo transfer phase of IVF.
If You Have Already Started HRT
If you are already on HRT and haven’t preserved your eggs, you’ll need to stop testosterone prior to starting ovarian stimulation and remain off it through the egg retrieval process, and possibly through the embryo transfer as well.
Additionally, the effects of testosterone on the ovaries and reproductive system may make egg retrieval more complex for those who have been on HRT long term.
Research from Boston IVF found that trans men who paused testosterone for around four months had similar egg retrieval outcomes to cisgender women undergoing IVF.
This pause can be physically and emotionally difficult, particularly for a trans man on hormones getting pregnant.
Why Do Trans Men Need to Stop Testosterone to Get Pregnant with IVF?
In addition to suppressing ovulation, testosterone may also thin or destabilize the uterine lining, which can make it more difficult for an embryo to implant successfully.
For a trans man on hormones getting pregnant, stopping testosterone may improve the chances of a healthy implantation, which is critical for pregnancy.
What to Expect from IVF as a Trans Man
- If currently undergoing HRT, you’ll pause testosterone under medical supervision
- Begin ovarian stimulation with hormone injections
- Monitor egg development via ultrasounds and bloodwork
- Undergo egg retrieval with light sedation.
Given the emotional and physical demands of IVF, it’s important to work with providers who affirm your identity. Some fertility clinics offer mental health support and gender-affirming care as part of the treatment process.
Fertility Preservation Before or After Starting HRT
If you’re thinking about starting testosterone or are considering pausing HRT to grow your family, fertility preservation can help you keep biological options open.
Here are two common methods:
- Egg Freezing: Involves harvesting eggs and freezing them unfertilized. This is often done before starting testosterone, but in some cases, it’s possible after stopping.
- Embryo Freezing: Embryos are created by combining your eggs with a partner’s or donor’s sperm. The resulting embryos are frozen for later use. This may be ideal if you know you want to pursue surrogacy later.
While outcomes are usually better before starting HRT, some trans men have preserved fertility even after hormone use.
Learn more about how embryos are frozen for surrogacy.
IVF Limitations After Long-Term Hormone Use
It’s important to acknowledge that long-term testosterone use can affect the success of IVF.
While many trans men have successfully completed IVF after pausing HRT, the effects of prolonged testosterone therapy on egg quality and uterine receptivity may lower the chances of implantation and overall IVF success.
For trans men who have been on hormones for several years, the reproductive system may respond less robustly to stimulation medications and the endometrial lining may not easily return to a state conducive for implantation.
Even with egg retrieval and fertilization, embryo transfer may not result in a pregnancy.
This is one reason why surrogacy may be a more effective and emotionally supportive path to parenthood, especially for a trans man on hormones getting pregnant or preserving fertility.
Why Surrogacy for Trans Men May Be a Better Option
If IVF is not successful after HRT or it doesn’t feel right for your body or identity, surrogacy is an option..
Higher Chances of Successful Implantation
From a medical perspective, surrogacy may offer a higher chance of success for trans men who have been on HRT long term. Testosterone can affect both egg quality and uterine receptivity, which can make pregnancy or embryo transfer more complex.
With surrogacy, these barriers are removed, and the embryo is transferred to a gestational surrogate whose body is fully prepared to carry a pregnancy.
You Won’t Have to Pause HRT for the Embryo Transfer
If you froze your eggs in advance or use donor eggs, surrogacy allows you to maintain your HRT regimen without interruption, avoiding the physical changes and emotional challenges that may come with pausing treatment for the embryo transfer or pregnancy.
Even if you pause testosterone for egg retrieval, that’s still less time that you have to pause treatment than if you carried the pregnancy yourself.
Avoiding Potential Gender Dysphoria Caused by Pregnancy
Surrogacy can help you avoid dysphoria that may arise from the hormonal shifts, body changes, sensations and psychological stress of pregnancy or childbirth.
This makes it an emotionally safer choice for a trans man on hormones getting pregnant or planning a family.
Surrogacy comes with emotional, financial and legal considerations, but for many, it provides a path that honors their identity and offers greater comfort.
Learn more about our LGBTQ+ surrogacy programs designed specifically for trans and queer families.
Can a Trans Man Use His Eggs in a Surrogacy Journey?
Yes, a trans man can use his own eggs to create embryos.
If you have frozen eggs or are willing to pause testosterone for egg retrieval, IVF allows your eggs to be fertilized with your partner’s sperm or a donor’s sperm. The resulting embryos can then be transferred to a surrogate.
Pausing HRT for the egg retrieval process can bring up dysphoria for some trans men, as it may involve temporary physical changes and emotional stress. Having a supportive and affirming care team can make a significant difference.
To support your well-being:
- Work with gender-affirming fertility providers.
- Request mental health support throughout treatment.
- Be prepared for side effects like bloating or hormonal shifts.
- Lean on your support system—friends, partners, therapists, and LGBTQ+ healthcare providers.
Using Donor Eggs: When Your Own Eggs Aren’t an Option
If using your own eggs doesn’t feel right for you, or if it isn’t possible, egg donor surrogacy is a valid and empowering alternative.
Many trans men choose this path for comfort, medical reasons or simply personal preference. Working with a surrogacy agency can help you explore egg donor options that align with your values and goals.
Your Family-Building Plan Starts Here
Family-building is a personal journey. Every trans man deserves options that honor and affirm who they are. We’re here to help. Reach out to connect with a surrogacy specialist and begin planning your future on your terms.