Fertility preservation for young trans and gender-diverse people

We asked parents and carers we talked to if they have thought about and discussed fertility preservation options with their children. We also asked whether fertility preservation was some-thing health professionals discussed with the young person. Here you can read and see what parents said about:
  • Discussing fertility preservation with the young person;
  • Discussing fertility preservation with health professionals; and
  • Their views of fertility preservation.

Oonagh talked about how as a parent you think about the long-term impact of hormone treatment and about discussing fertility with her daughter

Some medical treatments that trans and gender diverse people might have, including hormone therapy and surgery, can impact fertility. Oestrogen or testosterone hormone therapy are considered to impact on fertility in combination with other factors. However, science’s understanding of this area is rapidly changing.
Fertility preservation refers to procedures that allow sperm, eggs or embryos to be harvested, frozen and stored for later use in fertility treatment (Human Fertilisation & Embryology Authority, 2020).

Discussing fertility preservation with the young person

Parents and carers we spoke to felt that discussing fertility and fertility preservation with their children was important. They had carefully researched the available options and spent time preparing their children for the different choices available. At times, parents felt that they had to work hard to find reliable information and that they also needed to preempt any difficulties, as Leigh put it to be ‘2,3,4,5 steps ahead’ of everyone else.
Parents and carers who wanted to discuss fertility preservation with the young person found it could be challenging. Mel said that these were some ‘really big conversations’ that her and her partner wanted to have with her stepdaughter, who was at a cusp of puberty, and about to start on hormone blockers.

Mel said her stepdaughter wanted to have children and that they have discussed fertility preservation as a family and with the Gender Identity Development Services.

Some young people, whose parents we talked to, were not interested in preserving their eggs, or sperm. Josie said that her daughter was asked about it in the Gender Identity Development Services appointment, but did not think it was relevant to her. Andrew’s daughter was certain she did not want to explore fertility preservation options. He said: ‘She didn’t want to do anything about it. I think she probably thought it was a bit invasive.’
Children of some people we spoke to talked about alternative ways of having a family in the fu-ture. Kate’s son told her that he was sure he did not want children, but when she asked him about the possibility of changing his mind in the future, he said he ‘won’t mind if the child was biologically his or not’. The possibility of adopting a child in the future was also something that Ross’s child considered: ‘If, in the future at any point they do decide, they want a family then theres millions of children that need adopting and they would adopt a child.’

Kate said her son did not want children, but was open to having a child that was ‘not biologically his’, if he changed his mind in the future.

Discussing fertility preservation with health professionals

For some young people, whose parents we spoke to, fertility preservation was discussed in relation to starting on puberty blockers, or hormone therapy. For Richard’s daughter this discussion took place when his daughter saw the endocrinology specialist about getting puberty blockers.

Richard talked about his daughter being offered fertility preservation options by the endocrinologist.

Discussions around fertility preservation need to be handled with care as they often relate to parts of the body, about which young people feel sensitive (see also Managing body dysphoria and puberty related pressures). Ross, for example, described how ‘they didnt want the in-vasion of egg harvesting, because its an area of the body that they dont want looking at, playing with, touching, talking about, they dont even wanna think about that area of their body’. Another parent said their child was embarrassed ‘as most children would be sat in a room with adults talking about producing sperm’.
Lesley’s son was clear they did not want their eggs harvested, yet during an unrelated hospital stay, CAMHS professionals wrongly decided to take him off testosterone because they judged this decision to be best in light of fertility preservation. Lesley felt there was a lot of judgement and not enough deliberation.

Lesley said her son was taken off testosterone when he was an inpatient because the staff decided he was ambiguous about parenthood.

Some parents we spoke to felt that fertility preservation for trans young people was treated with less care than in other situations, for example, cancer, when young person’s fertility might be impacted by medical treatment.
Fertility preservation discussions can make the young person feel they are being prevented from accessing medication they urgently need. Ross talked about his child feeling they needed to go along with the suggestion to explore fertility preservation options, despite being against it and not wanting the ‘the invasion of egg harvesting.’

Ross said his child felt fertility preservation was a stalling tactic to stop them starting testosterone.

Parents and carers’ views of fertility preservation

Some parents we spoke to respected their child’s decisions regarding fertility preservation and some talked about alternative ways of becoming a parent, such as adoption. There was recognition that the age of their child was influential in thinking about these issues. Some parents felt the need to safeguard their child’s future ability to become a biological parent. Lisa felt it was important for young trans people to have the option to preserve fertility:

Lisa felt that it was important for her son to leave the door open to be able to have a baby.

For Leigh, who is a foster carer, safeguarding her foster son’s future meant taking the necessary legal steps with the local authorities. She felt there was not enough information about fertility preservation options for young trans people, their parents and carers. Leigh also spoke about the unequal support for fertility preservation for young trans people from the local authorities compared to non-trans young people that meant that for some people the only option was to pay for it privately.

Leigh talked about making sure her foster son has a choice regarding fertility preservation and how access to it was uneven across local authorities in England.

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