Fertility Desires and Reproductive Needs of Transgender People

Challenges and Considerations for Clinical Practice

Eva Feigerlová; Véronique Pascal; Marie-Odile Ganne-Devonec; Marc Klein; Bruno Guerci


Clin Endocrinol. 2019;91(1):10-21. 

In This Article

Concluding Remarks

Here, we discuss our current understanding of fertility desires and the parental needs of transgender and gender nonconforming people. Gender-affirming hormonal treatment, together with psychosocial and medical care, alleviates psychosocial suffering and decreases psychiatric morbidity in this population. Transgender and gender nonconforming people express the desire to have children and to create families. Based on ethical principles, these individuals have the same rights as cisgender persons to benefit from fertility preservation and assisted reproduction.[21,91]

The guidelines of the Endocrine Society and the World Professional Association for Transgender Health prompt health professionals to provide information on fertility risk and fertility preservation options before initiating hormonal treatment.[22,23] Currently, no clear tools are available for healthcare professionals. Among challenges for clinical care are a low clinical awareness, a lack of suitable psycho-educational instruments addressing fertility values that can be used to facilitate discussion between transgender persons and healthcare providers, a lack of established methods for fertility preservation in prepubertal youth and a lack of long-term data regarding reproductive function, psychological and societal outcomes in this population. Similarly, the current data are sparse regarding the experience of transgender and gender nonconforming people with fertility preservation.[63,92]

Transgender people assume parental roles in the manner of their self-identified gender identities; nevertheless, concerns regarding incongruence between the nature of conserved gametes and the gender identity may be raised.[93] According to a recent public opinion web-based study[94] including a representative sample of 1111 US residents (age range 18-75 years), the majority (76%) of the respondents considered that healthcare providers should help transgender persons to have their biological children, more than 60% of the participants agreed that gamete preservation should be offered to transgender people before hormonal treatment, and 60% declared that healthcare practitioners should help transgender men carry pregnancies.

The literature data highlight the inconsistent care and insufficient training of healthcare providers.[10,59,95,96] Medical practitioners should be aware of fertility issues in this population and refer patients to specialized centres. Healthcare providers should ensure adequate care with a multidisciplinary team approach and collaborate with general practitioners and community workers. Counselling sessions on fertility preservation should be part of the multidisciplinary work. Patient advocates and the parents of gender nonconforming youth should be invited to discussion sessions. The level of psychological maturity of each subject and associated medical conditions should be considered. Table 3 provides some considerations for clinical practice and research.

Further studies are necessary to improve our understanding of the reproductive needs and parental wishes of transgender and gender nonconforming people. In light of newly emerging societal challenges, healthcare standards sensitive to the needs of this population remain to be developed.