Dr. Saber’s Blog
The Importance of Fertility Preservation Counseling for Trans Men
When transgender men and transmasculine individuals begin their gender transitioning journey, one of the most important conversations they’ll have with healthcare professionals involves fertility preservation. It’s essential to think about keeping your options open for biological children in the future, even as you pursue gender-affirming treatments that align with your gender identity.
Let’s break down why this matters and what options are available, because understanding your reproductive health choices is part of comprehensive transgender healthcare.
Can gender-affirming treatments affect fertility?
Testosterone therapy and gender-affirming surgeries can significantly impact your ability to have biological children later on. While this might not be on your mind right now, it’s something worth considering before you start hormone replacement therapy (HRT) or undergo procedures like top surgery or hysterectomy.
Testosterone therapy and your reproductive system
When trans men begin testosterone therapy, it affects their menstrual cycle and ovulation. Many people find that their menstruation stops entirely, which can be a huge relief for those experiencing gender dysphoria around their reproductive organs. However, testosterone can cause changes in the ovaries that might impact future fertility.
The good news is that some research suggests that fertility may return after stopping hormone therapy, if that’s a decision you want to make to pursue biological children. However, there’s still a risk of permanent changes. That’s why healthcare providers increasingly recommend discussing fertility preservation methods before starting HRT.
Surgical considerations
Female-to-male gender affirming surgeries, like hysterectomy (removing the uterus) or oophorectomy (removing the ovaries), typically result in permanent infertility. While these procedures can be life-changing for mental health and overall well-being, they do close the door on carrying biological children.
Fertility preservation treatment options are available for transgender men
The field of assisted reproductive technology (ART) has come a long way, and there are several options for fertility preservation. Many of these options are the same as those used for cisgender women who are undergoing radiation or another health concern that could affect their fertility. Still, they are also applicable to transgender individuals, including trans men and nonbinary people assigned female at birth.
Egg freezing (oocyte cryopreservation)
This is probably the option most people are familiar with. The process involves:
- Temporary hormone stimulation (different from testosterone) to produce multiple eggs.
- A minor procedure to retrieve the eggs.
- Freezing them for future use with IVF.
The eggs can later be used with a partner’s sperm, donor sperm, or with a gestational carrier. Many trans men choose this option because it preserves their genetic material without requiring a partner at the time of preservation.
Embryo freezing (embryo cryopreservation)
If you have a partner or choose to use donor sperm, embryo freezing might be an option. This involves fertilizing retrieved eggs to create embryos, which are then frozen. Statistics show embryos have higher success rates than frozen eggs alone, but this option requires making decisions about a sperm source upfront.
Ovarian tissue preservation
This newer technique involves surgically removing and freezing a portion of ovarian tissue. It’s beneficial for transgender men who want to start testosterone therapy before puberty or reproductive maturation. Unlike other methods, it doesn’t require hormone stimulation, but it’s still considered experimental in many places.
Are there challenges to fertility preservation?
While these fertility preservation procedures may seem straightforward, that’s not always the case, especially for transgender people navigating an already complex healthcare system.
Emotional and mental health considerations
Many trans men experience conflicting feelings about fertility preservation. Since the procedures focus on reproductive organs, they can trigger or exacerbate gender dysphoria. There’s often tension between wanting to start testosterone therapy immediately and taking time for fertility preservation.
This is where working with healthcare providers experienced in transgender healthcare becomes essential, as compassionate physical and mental health support during this process is imperative. You want to choose someone, such as Dr. Sepideh Saber, who always remains sensitive to the needs of each patient and their mental and physical well-being.
Practical barriers
Finding knowledgeable healthcare professionals can be challenging. Not all reproductive endocrinologists or gynecology practices have experience with transgender patients. Some trans men end up traveling to access appropriate care. This can add financial and emotional stress.
Insurance coverage is another major hurdle. Most insurance plans don’t cover fertility preservation for transgender individuals. As a result, these procedures become financially challenging for many people.
The contraception conversation
Here’s something many people don’t realize: even on testosterone therapy, pregnancy can still occur. Healthcare providers emphasize that trans men who are sexually active with partners who produce sperm should consider birth control options. This is because breakthrough ovulation is possible, resulting in a fertilized egg and subsequent pregnancy.
Special considerations for pregnant trans men
It is worth mentioning that some trans people do become pregnant and give birth. Pregnant trans men face unique challenges in obstetrics care. For example, finding supportive healthcare providers and navigating everything from prenatal care to decisions about c-section delivery.
The experience of chestfeeding (the term many trans men prefer over breastfeeding) and lactation support requires healthcare professionals who understand both transgender healthcare needs and postpartum care. This is an evolving area where more education is needed across medical specialties.
The broader picture: LGBTQ and family building
Family building looks different for everyone. That’s especially true in the LGBTQ+ community. Some transgender individuals pursue biological children through fertility preservation and IVF. Others choose adoption or donor gametes. Some decide not to have children at all.
The key is having options and making informed decisions that align with your gender identity, life goals, and mental health needs. If possible, this should be done before pursuing gender affirmation procedures. But whether you’re just starting to consider hormone therapy or you’re years into your gender affirming transition, it’s never too late to have conversations about reproductive health with knowledgeable healthcare providers.
Finding the right support
If you’re considering fertility preservation, look for medical professionals who:
- Have experience with transgender patients.
- Understand the intersection of gender identity and reproductive health.
- Can provide both medical expertise and emotional support.
- Work collaboratively with your existing healthcare team.
Remember, this decision is deeply personal. There’s no right or wrong choice – only what’s right for you, your gender identity, your mental health, and your future family planning goals.
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Considering gender-affirming plastic surgery? Consider Dr. Saber
Access to gender-affirming plastic surgery improves quality of life, mental health, self-image, and overall well-being. That’s why Dr. Sepideh Saber, M.D., is proud to provide a variety of cosmetic surgeries and procedures for trans and nonbinary patients, including breast reduction and removal, transgender body contouring, and facial feminization surgery.
Dr. Sepideh Saber is a renowned plastic surgeon based in Los Angeles. She specializes in gender-affirming surgeries and cosmetic procedures. She believes in empowering her patients through knowledge, empathy, and expert care.
Call us at (877) 205-4100 or schedule a consultation online.
The practice of Dr. Saber is located in Encino, CA, for patients throughout the Los Angeles area. We are also convenient to Encino, Woodland Hills, Sherman Oaks, Calabasas, Burbank, Glendale, Hidden Hills, Agoura Hills, Northridge, North Hollywood, Malibu, Topanga, Canoga Park, Reseda, Valley Glen, Chatsworth, West Hills, Winnetka, Universal City, Bel Air, Beverly Hills, Downtown Los Angeles, Silverlake, and Echo Park.ge, North Hollywood, Malibu, Topanga, Canoga Park, Reseda, Valley Glen, Chatsworth, West Hills, Winnetka, Universal City, Bel Air, Beverly Hills, Downtown Los Angeles, Silverlake, and Echo Park.
Fertility Preservation for Trans Men FAQs
Can I freeze my eggs while on testosterone?
Unfortunately, no. Testosterone suppresses egg maturation, so you’ll need to stop hormone therapy and allow your menstrual cycle to return before egg freezing. This process typically takes a few months. Many trans men find this challenging due to the return of menstruation and potential gender dysphoria.
Do I need to be off testosterone for a long time for fertility preservation?
The timeline varies, but most healthcare providers recommend stopping testosterone therapy for 2-4 months before starting the egg retrieval process. Your reproductive endocrinologist will monitor your hormone levels and menstrual cycle to determine the right timing.
Can transgender men produce sperm?
No, trans men assigned female at birth cannot produce sperm, as this requires the genital structures, namely testes, to be able to do so. However, there are many paths to biological children through egg preservation, and various family building options including donor sperm, adoption, and surrogacy.
Can transgender men get pregnant?
Transgender men can become pregnant through sexual intercourse with biological men, even during hormone replacement therapy, but not after gender affirming surgeries like hysterectomy or oopherectomy.
Is pregnancy possible while on HRT?
Yes, breakthrough ovulation can occur even while on testosterone therapy. Healthcare professionals recommend that sexually active trans men who could become pregnant use contraception if they don’t want to conceive.
What about nonbinary people – are the options the same?
Nonbinary people assigned female at birth have the same fertility preservation options as trans men and cis women. The key is working with healthcare providers who respect your gender identity while providing comprehensive reproductive health care.
How does this affect my transition timeline?
This varies for each person. Some transgender individuals choose to preserve fertility before starting any hormone therapy or gender surgery, while others may pause their medical transition temporarily. We recommend discussing your priorities and timeline with both your gender-affirming care provider and reproductive health specialist.
Sources:
Reproductive wish in transsexual men
https://doi.org/10.1093/humrep/der406
Fertility preservation in the transgender patient: expanding oncofertility care beyond cancer
https://doi.org/10.3109/09513590.2014.920005
Fertility preservation for transgender children and young people in paediatric healthcare: a systematic review of ethical considerations
https://pubmed.ncbi.nlm.nih.gov/34980674/
Considerations in genetic counseling of transgender patients: Cultural competencies and altered disease risk profiles
https://pubmed.ncbi.nlm.nih.gov/33368789/
Fertility preservation counseling needed for transgender men
https://medicalxpress.com/news/2022-09-fertility-transgender-men.html
Dr. Saber offers a more sensitive, female perspective for patients of all ages, genders, and orientations. Former patients from all walks of life have praised not only their treatment outcomes but her caring, thoughtful approach to a wide array of appearance and health-related matters.
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Dr. Sepideh Saber, MD, FACS
👩🏻⚕️ Board Certified Plastic Surgeon
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I was fortunate to find Dr. Saber after researching board-certified surgeons who specialize in breast cancer reconstruction revision surgery. I knew I was in good hands from the moment I spoke with the lovely and efficient Marlene, Dr Saber's office manager. Dr Saber patiently listened to my concerns and, after examining me, explained what I could realistically expect the outcome to be from another surgery. She also explained to me that she would need to review my previous surgery notes before we could discuss a possible further surgery, which I found comforting and highly ethical. I also discussed a couple of other procedures that I would like done, including fat removal from my large upper arms that had caused me great embarrassment for several years. Dr. Saber is an excellent surgeon who is incredibly kind and genuine. She truly understands the female body and the emotional aspect of body insecurities yet, she is transparent about what can and cannot be done and takes time to discuss realistic expectations and outcomes. My breast reconstruction revision surgery will take place in the New Year, but in the meantime, I have the most fabulous upper arms that I recently flaunted in a strapless dress (something I have not done in years). Dr Saber is truly one of a kind, and I still cannot believe how fortunate I am to have found her. I highly recommend Dr Saber.
I don’t have enough wonderful words to describe Dr Saber and Marlene! I had a tummy tuck done this year and from start to finish the entire experience was amazing. Marlene is always so helpful and works so hard to make every detail a breeze for you. When I had my consultation with Dr Saber I was at a point of complete agony with my body. She instantly took that stress and frustration off my shoulders! As a woman not being heard by doctors for years I left that consultation with happy tears knowing I had finally found my Dr. It was a major surgery and I felt completely zen and at peace going in because she really does make you feel that safe. I didn’t think I would ever look the way I do now! She gave me the gift of having the body I kept fighting for. I will never stop recommending her.
I saw Dr. Saber when I broke my wrist. I ended up having to have surgery. She did an excellent job and I am healing nicely. She was very professional, but was also very kind and compassionate. I would highly recommend her!!
I LOVED DR SABER!!! There are a few reasons why I chose her. One was because she’s a female Doctor that was my goal who also did a good job (which I was able to confirm with all her before and after photos) and what sold me was my safety in mind. She made me feel like I was in the best hands ever along with Marlene who coordinated everything THANK YOU LADIES! Dr Saber helped me get back the body I have always desired. I had a lot of stomach fat from weight gain and I lost weight so a lot of my weight was in my front lower and upper abdomen. Now I have a super beautiful curvy body like an hourglass after a tummy tuck and lipo she did. She understood the assignment hahaha . I’m 32 years old no kids just wanted to enjoy my younger body looking and feeling beautiful and she really took good care of me. Even after hours I had an emergency due to my fault but she was there and got back to me very quickly and I’m very grateful. I also think her work says a lot because I stopped taking pain medication on the 3rd day after surgery and was fine with very minimal pain I was able to tolerate the healing process. Highly recommend going with her I just had a wonderful experience and would do it all over again if I had too. Maybe after I have kids. Thanks Dr Saber and team <3
Dr.Saber is by far one of the best plastic surgeons. I love how she takes her time to explain any procedure to the patients understanding. She always makes sure to answers any and all questions.From fillers to body contours she’s the one you want.
Dr Saber is amazing! She is caring and very informative. I went in for fillers and she explained procedure step by step. I highly recommend her and look forward to future visits.
Dr. Saber was friendly, knowledgeable and professional. She took time to listen, answer all my questions and was forthright in her recommendations. Her staff was friendly and helpful. I was very happy with the results and plan on going back. If you are looking for a first rate professional experience look no further she is the doctor for you!
Dr. Saber is one of a kind plastic surgeon with a heart of gold. She is a well verse plastic surgeon that puts her patient's needs before anything else. She genuinely cares about every single patient, and her work speaks for itself. I notice every post-operative result on her Instagram (@saberplasticsurgery) the patients have this glow that radiates through. I have been going to Dr. Saber for my Botox for the past 3 years, and love the results every time. I know who I will be going to for any future plastic surgery needs, and will confidently refer family and friends to Dr. Saber for any Botox, fillers, and plastic surgery consultations.
I have nothing but great things to say about Dr. Saber! I am so pleased with my results from a breast augmentation she performed on me back in late June! She answered all my questions and concerns before and after my surgery. She’s very easy to get in contact with and she’s so nice. She made feel so comfortable throughout the whole process. 100/10 Lover her work!!
Dr Saber is hands down the best surgeon! She took her time answering my questions and explained procedure in detail. After doing liposuction six months ago, I am extremely happy with my results and I appreciate her so much.
Dr. Saber is so kind and thorough with her patients! She is an amazing doctor and genuinely cars about everyone she comes in contact with. I would recommend her to anyone for any hand surgery or cosmetic procedure.
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