Transgender Fertility Preservation And Sperm Freezing

For transgender individuals, sperm freezing is likely part of the discussion around preserving fertility. This article will explore fertility challenges among the transgender community and sperm freezing as an effective preservation method.

  1. Why Should Transgender Individuals Consider Fertility Preservation?
  2. Is Sperm Quality In Transgender People High Enough For Storage?
  3. How Can I Perform Sperm Freezing?
  4. Does Sperm Freezing In Transgender Affect Sperm Quality?

Why Should Transgender Individuals Consider Fertility Preservation?

1. Desire for Children

Various surveys show that roughly 25% to 50% of transgender participants are parents. In one survey, 54% of transmen desired children. Additionally, surveys showed that 51% of participants would have chosen sperm preservation if they had known about it.

These statistics indicate a strong desire in the transgender community to preserve their fertility and to have children.

If you are considering hormone therapy, and want biological children, you may want to consider fertility preservation. It’s important that you discuss fertility with your medical professional.

2. Effects Of Gender-Affirming Therapies

Gender-affirming therapies are of two types:

  • Hormonal treatments
  • Surgical options

Individuals either choose removal of testes and penis or opt for testosterone-suppressing medications.

Impacts of surgery on transgender fertility

Surgical interventions have irreversible impacts. If you undergo the removal of testes and penis, the production unit for spermatogenesis shuts down. You cannot produce sperm, and irreversible infertility sets in.

Impacts of hormonal treatments on transgender fertility

Hormonal therapies have less permanent implications. Estrogen is given to counter male reproductive hormones. It reduces the expression and production of testosterone. A significant decline in androgens leads to shrinkage of testes and sperm formation.

The semen analysis of transwomen on estrogen therapy shows the absence of sperm. However, this effect is reversible.

If you discontinue hormonal treatments for three months, your spermatogenesis restores. The reversal of sperm count is slower and less prominent, but sperm motility shows rapid improvement.

Experts are still divided on the quality of sperm, though. The extent to which you gain sperm production is unpredictable and hard to quantify. Those who have never used hormones show the highest quality of sperm.

Is Sperm Quality In Transgender People High Enough For Storage?

A semen analysis test can give you an idea about your sperm health. If you have not started hormone replacement therapy, your sperm parameters will likely be in the normal range.

The sperm quality in transwomen is comparatively lower than in the general population. However, the impact is not enough to affect the pregnancy rate. You can still achieve a pregnancy using these sperm. It, however, can change after hormonal replacement.

How Can I Perform Sperm Freezing?

The procedure is simple. The sample is collected through masturbation. This can be done either at a fertility clinic, or at using an at-home option like the Ro Sperm Kit.

Many pre-pubertal children choose gender-affirming therapies before they can masturbate. For them, testicular tissue is stored for fertility preservation. Additionally, many individuals find it emotionally challenging to masturbate for sample collection. If you feel anxious, you can opt for sperm aspiration, in which sperm are collected by introducing a needle in the testes.

Does Sperm Freezing In Transgender Affect Sperm Quality?

It depends on the quality before freezing. The research shows that thawing a semen sample of produces enough sperm to cause pregnancy or accomplish in-vitro fertilization.

In short, sperm freezing is a non-invasive process and can be done after checking sperm quality through semen analysis. It is a guaranteed preservation method for trans individuals and you should choose it without a second thought.

  1. Cheng, Philip J et al. “Fertility concerns of the transgender patient.” Translational andrology and urology vol. 8,3 (2019): 209-218.
  2. I de Nie, A Meißner, E H Kostelijk, A T Soufan, I A C Voorn-de Warem, M den Heijer, J Huirne, N M van Mello, Impaired semen quality in trans women: prevalence and determinants, Human Reproduction, Volume 35, Issue 7, July 2020, Pages 1529–1536
  3. P. De Sutter, M.D., Ph.D., K. Kira, M.Sc., A. Verschoor and A. Hotimsky. “The Desire to have Children and the Preservation of Fertility in Transsexual Women: A Survey”,Volume 6, Number 3, 2002
  4. Sterling, Joshua, and Maurice M Garcia. “Fertility preservation options for transgender individuals.” Translational andrology and urology vol. 9,Suppl 2 (2020): S215-S226.

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Some sperm is lost and damaged during the transport, storage, freezing, and thawing process. The semen analysis reflects values at the time of the analysis, after transport and before freezing. These values will decrease throughout the freezing and thawing process. A semen analysis alone cannot be used to predict fertility.
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