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Family building and fertility in trans people

Written by our guest contributors, Sheryl A. Kingsberg, Ph.D, and Gail A. Knudson, MD.

The desire to have and/or raise children is as likely to be experienced in transsexuals, transgender and gender nonconforming people as any other individual. In order to transition to one’s gender congruent self, individuals may elect hormonal and surgical therapies. These therapies can interfere with the ability to reproduce using one’s own gametes (i.e. sperm and eggs) as well as carry a pregnancy. In fact, until recently transitioning to one’s desired gender and reproduction was considered mutually exclusive and seen as the price to pay (de Sutter, 2001).

Although the reproductive needs and rights of trans people were recognized as legitimate over a decade ago, many medical experts are still biased against procreation after gender reassignment. In 2001 the World Professional Association of Transgender Health’s Standards of Care (WPATH SOC) for Transgender Health Version 6 included one paragraph on the need to discuss reproductive issues with trans people prior to the start of hormonal treatment. In contrast, the recently released Version 7 of the WPATH SOC includes an entire chapter on fertility counselling and reproductive options.

Assisted reproductive technology options available to trans women include cryopreservation (freezing) of sperm or testicular tissue. Sperm can be used to fertilize eggs of a genetically female partner or a donor and the partner or gestational carrier would carry subsequent embryos.

Options available to trans men include oocyte (egg) freezing, IVF/donor sperm and embryo cryopreservation (freezing). Eggs can be fertilized at a later date and a female partner or a gestational surrogate, or the trans man may carry subsequent embryos if he has chosen to preserve his uterus for this purpose.

The Complete Lesbian and Gay Parenting Guide written by Arlene Istar Lev includes a great deal of information about trans family building and is an invaluable resource for trans people considering having children.

It is also important to know what your legal rights are as a trans parent. The recently published book, Transgender Family Law: A Guide to Effective Advocacy, edited by Jennifer Levi and Elizabeth E. Monnin-Browder is an essential guide to understanding the pertinent legal issues. Levi states that the goals of the book are reversing bad precedent, establishing favorable outcomes, and changing public attitudes.

Definitions

Transgender – A diverse group of individuals who cross or transcend culturally defined categories of gender.  Their gender identity differs to varying degrees from the sex they were assigned at birth (Bockting, 1999).

Gender nonconforming – Term to describe an individual whose gender identity, role, or expression differs from what is normative for their genetic (or more likely phenotypic expression) in a given culture.

Gender dysphoria – Distress that is caused by a discrepancy between gender identity and sex assigned at birth, i.e. the primary and secondary sex characteristics and/or the gender role associated with that assigned sex (Fisk, 1974; Knudson, de Cuypere, & Bockting 2010).

Trans men – individuals assigned female at birth who are changing or who have changed their body and/or gender role from birth-assigned female toward a more masculine body or role.

Trans women – individuals assigned male at birth who are changing or who have changed their body and/or gender role from birth-assigned male toward a more feminine body or role.

Transition – The period of time for a transsexual, transgender, or gender nonconforming person to change (transition) his or her gender role (and from the role associated with their sex assigned at birth to a different gender role).  For many, this involves learning how to live socially in “the other” gender role; for others this means finding a gender role and expression that is most comfortable for them.  Transition may or may not include feminization or masculinization of the body through hormones or other medical procedures.

Transsexual – Term applied by the medical profession to refer to individuals who seek to change or who have changed their primary and/or secondary sex characteristics through feminizining or masculinizing medical interventions (hormones and/or surgery), typically accompanied by a permanent change in gender role.

Sex reassignment surgery (gender affirmation surgery) – Surgery to change a person’s primary and/or secondary sex characteristics to match a person’s gender identity.

Links:

WPATH Standards of Care Version 7: www.wpath.org

Transgender Family Law: A Guide to Effective Advocacy edited by Jennifer L. Levi and Elizabeth E. Monnin-Browder (2012)
For further information about this book, click here.

The Complete Lesbian and Gay Parenting Guide by Arlene Istar Lev
For further information about this book, click here.

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