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Starting hormone replacement therapy (HRT) is a powerful and affirming step in your transition. But if you're also thinking about building a family someday, preserving fertility before HRT can give you more options down the road.
Many trans people face a tough decision: Begin gender-affirming treatment now or pause to think about future parenthood. Taking steps today can protect your chance to have a biological child later, if that matters to you.
This guide will help you understand how HRT affects fertility, explore options like egg and sperm freezing and explain how surrogacy can help you build your family after transitioning. For more information, fill out our online form.
How does HRT affect fertility? For trans women, estrogen therapy reduces testosterone levels, which can significantly decrease sperm production and quality. For trans men, testosterone therapy typically stops ovulation and menstruation, affecting egg production and reproductive cycles. Over time, this suppression can become permanent. Some fertility may return if hormone therapy is temporarily stopped, but this isn't guaranteed. That means it may not be possible to have a biological child without having taken fertility preservation steps in advance. For many people, it's easier to preserve fertility before HRT begins. Trying to pause treatment later to retrieve sperm or eggs can be emotionally and physically difficult. Planning ahead now gives you more control and fewer medical barriers later.Why Fertility Preservation Matters Before HRT
3 Options for Preserving Fertility Before HRT
You have a few different paths depending on your body, your plans and what feels most affirming to you:
This process involves stimulating the ovaries to produce multiple eggs, which are then retrieved and frozen for future use. The process typically takes two to six weeks and requires multiple clinic visits for monitoring. This option preserves your eggs at their current quality, allowing you to use them later with a partner's sperm or donor sperm. This process is generally faster and less invasive than egg freezing. Multiple samples are typically collected over several days or weeks to ensure adequate storage. The samples are then frozen and can remain viable for many years. If you have a partner or plan to use a donor, you can create and freeze embryos through in vitro fertilization (IVF). Embryo freezing can offer higher success rates, as embryos are more resilient to the freezing and thawing process than eggs or sperm.
Some people choose to freeze eggs and sperm before transitioning to give themselves maximum flexibility in the future.
Should I Preserve My Eggs Before HRT?
If you’re a trans man with ovaries, preserving your eggs before HRT may be an option. The egg retrieval process includes several steps: daily hormone injections, regular ultrasounds and a short outpatient procedure to collect the eggs.
This process can trigger dysphoria for some trans men, especially during hormone stimulation. Working with a fertility clinic experienced in gender-affirming care can help minimize these challenges,
Should I Preserve My Sperm Before HRT?
For trans women, freezing sperm before HRT is often a simpler and quicker process. It involves collecting samples and testing for sperm quality. You may need to provide multiple samples to get a viable quantity for future use.
Once frozen, your sperm can be used later for IVF procedures, either with a partner or through surrogacy arrangements.
Fertility preservation involves emotional considerations that are unique to trans individuals. Trans men may experience gender dysphoria during ovarian stimulation and egg retrieval procedures, and trans women may struggle with the reality that they won't be able to carry a pregnancy themselves. Finding affirming fertility clinics is crucial for a positive experience. Look for providers who use inclusive language, respect your chosen name and pronouns and have experience working with trans patients. Mental health support during this time can be invaluable. Consider working with a therapist who specializes in fertility counseling before HRT to help navigate the complex emotions that may arise during the preservation process.Navigating Fertility Preservation as a Trans Individual
How Surrogacy Can Support Your Parenthood Goals
Surrogacy offers a powerful solution for trans people who want to become parents. If you've preserved eggs, sperm or embryos before HRT, these can be used in IVF procedures with a gestational surrogate. The surrogate carries the pregnancy, but the child can still be biologically related to you.
This path honors your transition while making parenthood possible. For trans women, surrogacy allows you to have a biological child using your preserved sperm. For trans men, a gestational carrier can carry a pregnancy using your preserved eggs. Surrogacy offers a path to parenthood that honors your transition while helping you achieve your family-building goals.
The surrogacy process involves matching with a surrogate, completing legal contracts and supporting the surrogate throughout the pregnancy. Many intended parents find this journey deeply rewarding. It creates a path forward that honors who you are and the family you hope to build.
Understanding the financial side can help you plan effectively. Here's a breakdown of typical costs: Egg retrieval and freezing: $8,500 - $14,000 (plus $500 - $1,000 a year for storage) Sperm banking: $500 - $1,000 (plus $100 - $500 a year for storage) Embryo freezing: $1,000 - $2,000 (plus $500 - $1,000 a year for storage) Surrogacy: $100,000 - $200,000+ Some insurance plans may cover fertility preservation if it's tied to a medical need. There are also LGBTQ+ grants and fertility-specific loans that can help. Learn more about affording your journey.Costs and Coverage for Fertility Preservation and Surrogacy
Working With a Surrogacy Agency That Understands LGBTQ+ Needs
Choosing the right surrogacy agency is crucial for trans intended parents. You need a partner who respects your identity and understands your unique path. Look for an agency with experience supporting trans intended parents, and ask whether their team is trained in gender-affirming care.
American Surrogacy supports all family-building journeys. Our team understands the unique considerations involved in preserving fertility before HRT and can help you navigate the surrogacy process when you're ready to build your family.
Parenthood is possible after HRT, and we can help you plan for it. Whether you're just beginning to consider fertility preservation or ready to explore surrogacy options, our experienced team can provide the guidance and support you need.