5 Year Plan

I’m a transman that has been on testosterone for 3 years. Where do I start if I want to extract, fertilize, and freeze my eggs so that my girlfriend can carry our child in approximately 5 years? Approximately how long will I have to be off testosterone/ take other hormones to get the specimens needed for later?

Written by our medical expert Dr. Stephen Hudson, Director of the Victoria Fertility Centre in British Columbia, Canada. 

There are a number of issues that need to be addressed in your question, so I will break it down into parts. There are some unknowns about you (such as your and your partner’s ages, and the type of testosterone you are on) which make it difficult for me to be specific, however I will try and address this more generally. I am assuming you have your ovaries intact.

Testosterone can be administered orally, transdermally (through the skin), or more commonly by injection. In addition to providing the desired masculinizing effects, it also suppresses the pituitary gland and thereby shuts down the ovaries. Many of the bodily changes caused by testosterone are irreversible, however not so with the ovaries. After stopping the testosterone therapy, in most cases the pituitary gland will again start sending the right signals to the ovaries (in the form of FSH and LH) and “wake them up”.

Although there can be variations from person to person, in most cases the ovaries will recover within a few months. Even if menstruation does not resume, the ovaries will usually respond well to fertility drugs for the purpose of retrieving eggs.

Although you have indicated that you plan on starting your family in 5 years time, I think your idea to freeze eggs now is a good one. This would ensure that you are retrieving younger and healthier eggs, and would not disrupt your testosterone therapy at a later date. The freezing technology has improved dramatically over the past 5 years, and now both embryos and eggs can be successfully and reliably frozen (the process is called vitrification).

Therefore, this is a suggested timeline with explanations:

  1. Consult with a reproductive endocrinologist at a Fertility Clinic. At this time a history would be taken from you and your partner, and an examination done on both of you. Your examination would include a transvaginal ultrasound to ensure that your ovaries are accessible for egg retrieval.
  2. After being off the testosterone therapy for 6-8 weeks, some blood tests and an ultrasound will indicate how your ovaries have recovered. This would also allow evaluation of your ovarian (egg) reserve.
  3. You would then be prescribed fertility drugs (called gonadotrophins) which are given by daily injections. These hormones stimulate the ovaries to produce lots of eggs. The eggs grow in small capsules of fluid called follicles – which can be monitored by ultrasound examinations. You would normally need to take the injections daily for about 14 days to grow the follicles and mature the eggs.
  4. When the majority of the eggs are estimated to be mature, the eggs are retrieved through the vagina, by passing a fine needle alongside the ultrasound probe into the follicles and aspirating the fluid.
  5. Once the eggs are retrieved, they can either be frozen as eggs, or fertilized with sperm, and frozen as embryos. Your physician can guide you and your partner as to the pros and cons of freezing eggs or embryos.
  6. Immediately after this – you could resume your testosterone therapy.

In summary, I would hope that you would only need to be off your testosterone therapy for about 8 – 12 weeks. I hope this helps you understand your options.

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