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Information on fertility, fertility preservation, and family planning before starting gender-affirming treatment.
If you’re experiencing gender dysphoria, fertility might feel like the last thing on your mind.
Many trans+ and non-binary people understandably want to begin gender-affirming treatment as soon as possible to feel more at home in their bodies, and that makes complete sense.
At the same time, we’ve heard from people who later wished they’d had the chance to explore fertility preservation before starting treatment. We’re sharing this information now so you can make the choice that feels right for you, with all your options on the table. There’s no pressure either way; this is entirely your decision.
This page is for guidance only and is not a substitute for medical advice.
Treatment decisions should always be made with a qualified healthcare professional.
Most people don’t have a clear picture of their fertility status before starting gender-affirming care. Research in this area is still developing, but what we do know is that hormone treatment typically reduces egg or sperm production.
For some people, these changes can make it more difficult, or sometimes impossible, to have biological children later on.
Before starting treatment, it may be worth considering whether you would like the option of having biological children in the future, even if you’re unsure right now.
You may want to think about:
Generally speaking, storing sperm tends to be simpler and less invasive than storing eggs, though both options are available to some people.
If you’re supporting a transgender young person, fertility is something you may wish to discuss together when the time feels right.
Puberty blockers are designed to pause puberty and are generally considered reversible when stopped. However, there is an important timing consideration: young people who begin puberty blockers early may not reach the stage of development needed to produce eggs or sperm for storage.
This can create a difficult situation. Waiting until eggs or sperm develop may mean a young person experiences further masculinisation or feminisation, which can be genuinely distressing.
These are complex decisions with no universal right answer. They deserve careful, compassionate discussion with healthcare professionals who understand your young person’s individual needs and priorities.
Different gender-affirming medical interventions can affect fertility in different ways. In many cases, these effects depend on how long treatment continues and whether it is stopped later. Research is still developing, but the following overview reflects what clinicians currently understand.
Timing is a key factor for younger individuals. Puberty blockers pause physical development, which may prevent the body from reaching the stage at which eggs or sperm can be produced and stored. For transgender individuals who have already gone through puberty, puberty blockers are typically regarded as reversible.
In these cases, the puberty blocker works by suppressing the body’s hormone production, supporting the use of gender-affirming hormones rather than pausing the pubertal process.
Anti-androgens reduce the effects of testosterone in the body. They can suppress sperm production and erections, though fertility may sometimes return if treatment is stopped.
Oestrogen therapy suppresses sperm production. Fertility may recover if treatment stops, but this does not happen in every case. See this 2023 international study on trans women’s fertility preservation for more information.
Testosterone can reduce egg production and overall fertility. However, some transmasculine people have paused testosterone in order to conceive. (See the Trans Pregnancy Project for more information.)
It’s also important to know that testosterone is not a contraceptive. If you are taking testosterone and have a uterus and ovaries, pregnancy is still possible. Because testosterone can harm a developing foetus, anyone having sex that could result in pregnancy should use effective contraception if they do not want to conceive. A healthcare provider can help you find contraception options that work for your body and circumstances.
The WPATH Standards of Care (Version 8, Chapter 16) provides current guidance on reproductive health, fertility preservation, pregnancy, contraception, and related care for gender-diverse people.
Fertility preservation is a personal decision, and there is no requirement to pursue it before starting gender-affirming treatment. Some people choose to freeze eggs, sperm, or embryos before beginning medical care, while others decide this isn’t the right option for them.
If you have already gone through puberty, you may be able to store eggs, sperm, or embryos for possible future use. These can remain frozen until you decide whether or not you want to use them.
People’s feelings about parenthood can evolve over time, and it’s common for fertility decisions to feel uncertain. Your future options for egg or sperm storage, or for becoming pregnant, will depend on several factors, including any hormone therapy or surgeries you’ve had.
If you ever want to explore your options, a healthcare provider or fertility specialist can talk through what might be possible in your individual situation and help you consider next steps at your own pace.
This usually involves providing a sperm sample through masturbation or vibratory stimulation. If this isn’t comfortable or possible for you, sperm can sometimes be surgically retrieved, though this is more invasive.
This involves taking fertility medication to stimulate your ovaries, followed by a minor surgical procedure (done under sedation) to collect the eggs. It’s generally safe, though in rare cases it can cause a condition called ovarian hyperstimulation, which may need hospital treatment.
Frozen eggs, sperm, or embryos can be stored for many years. In the UK, you can store for up to 55 years by renewing your consent every 10 years.
We want to be upfront about costs, as they can add up over time:
Some clinics offer payment plans or financial assistance, so it’s worth asking. If you’re ever unable to continue paying storage fees, you’ll need to make decisions about what happens to your stored gametes. Therefore, it’s advisable to discuss these scenarios with your clinic before you begin.
Some NHS services may cover fertility preservation costs for trans people undergoing medical transition, but this varies depending on where you live. It’s worth asking your gender clinic or GP about what might be available in your area.
This depends on several factors, and we’re honest that research specifically on trans+ people’s stored gametes is still fairly limited. However, here’s what we do know:
The NHS provides statistics for IVF success rates, though these are based on general population data rather than trans-specific outcomes. Your fertility clinic can provide you with more personalised information tailored to your individual situation.
It’s also worth remembering that stored gametes represent one option, but not the only path to parenthood. Adoption, fostering, co-parenting arrangements, and using donor gametes are all equally valid ways to build a family.
Fertility Network UK: Free and impartial support, advice and information for anyone affected by fertility issues.
Human Fertilisation and Embryology Authority (HFEA): Information for trans and non-binary people seeking fertility treatment from the UK’s fertility regulator.
NHS IVF information: Guidance on IVF treatment, eligibility and success rates.
Trans Fertility Co: a community-created resource to make fertility options easier to navigate
The Trans Pregnancy Project: Research, information and personal stories from trans men, transmasculine and non-binary people who have experienced pregnancy.
WPATH Standards of Care (Version 8): Current clinical guidance on reproductive health, fertility preservation, pregnancy and contraception for gender-diverse people.
EachOther: NHS revises guidance on transgender fertility services after legal case dropped: An article exploring changes to NHS fertility guidance and the experiences of trans people navigating fertility care.
Fertility preservation and realignment in transgender women (international study, 2023)
Fertility decision-making among Australian trans and non-binary adults
Take the first step with Anne Health.
We’re here to guide and support you with inclusive, gender-affirming care built around you.