Before having gender-affirming surgery, it’s important to know how it can affect family planning. Some surgeries make it harder to have children. Knowing the effects and all of the options can help people make smart choices before surgery.
Understanding the Connection Between Gender-Affirming Surgery and Fertility
For transgender individuals, gender affirming surgery can help them feel more like themselves. But many of these surgeries can affect the ability to have children.
Surgical procedures like a hysterectomy (removal of the uterus), oophorectomy (removal of the ovaries) and orchiectomy (removal of the testes) can affect reproductive potential. After these procedures, the ability to have children is reduced.
Other treatments, like long-term hormone therapy, have ripple effects. This could also potentially lower fertility rates. Increased estrogen may reduce egg quality and increased testosterone can decrease sperm production.
Those considering gender-affirming surgery are encouraged to talk with healthcare providers early. Learning about both the benefits and effects allows transgender people to make informed choices. This allows you to have control over future family-building options.
Fertility Considerations for Common Procedures
Different gender-affirming surgeries have different impacts on fertility. Here is an overview of some common procedures.
Transfeminine Patients
- Orchiectomy (removal of the testes): This surgery permanently stops sperm production. Without sperm, natural conception is not possible.
- Vaginoplasty (creation of a vagina): This procedure happens after the orchiectomy, which means fertility is permanently reduced after surgery.
Transmasculine Patients
- Hysterectomy (removal of the uterus): This surgery ends the ability to carry a pregnancy.
- Oophorectomy (removal of the ovaries): This procedure stops egg production, which ends the ability to provide eggs for conception.
Surgeries That May Leave Fertility Partially Intact
Some surgeries do not remove reproductive organs. In these cases, fertility may still be possible. If the ovaries or testes remain, hormone levels and long-term organ health may still lower fertility rates.
Hormone Therapy
Even without surgery, hormone therapy can lower fertility.
- Estrogen therapy may reduce sperm count and quality.
- Testosterone therapy may stop ovulation and lower egg quality.
- Pausing hormones sometimes allows fertility to return, but not always.
That’s why it’s important to talk about reproductive health with a doctor before starting hormone therapy or having surgery.
Exploring Fertility Preservation Options
Many affirmation surgeries change fertility permanently. Here are ways to protect reproductive potential before surgery. Planning ahead can give transgender patients more fertility preservation options in the future.
Sperm banking can be an option for transfeminine patients before orchiectomy or hormone use. Sperm samples are frozen and stored so they can be used in fertility treatments like in vitro fertilization (IVF) or intrauterine insemination (IUI) in the future.
Egg freezing can be an option for transmasculine patients. This takes place before oophorectomy or prolonged testosterone therapy. Eggs are collected and frozen for future use. Like sperm, they can later be used for IVF.
Embryo freezing involves the process of fertilization with a partner’s or donor’s sperm and egg before freezing. It’s often used with fertility treatments that create embryos, like IVF, and can help people preserve fertility.
Adoption is often another path to parenthood. Not everyone chooses to preserve fertility biologically. Adopting and fostering are meaningful ways for transgender people to build families.
Fertility preservation can be costly. Health insurance may or may not cover it. Patients should ask about their coverage and explore programs that can provide financial assistance.
These decisions can feel overwhelming. Balancing the urgency of surgery with long-term family goals is not easy. Talking with supportive healthcare providers, mental health professionals and fertility specialists can help patients make decisions that honor their gender identity and their future hopes.
Empowering Conversations with Healthcare Providers
Choosing gender-affirming surgery is a personal and powerful step. Because these surgeries can have long-term effects on fertility, it’s important to talk with doctors early. Patients should feel comfortable asking surgeons and fertility specialists questions such as:
- How certain surgeries may affect the ability to have biological children
- Options for fertility preservation, such as sperm banking, egg freezing or embryo freezing
- What financial support is available through insurance
By discussing these topics before surgery, transgender patients can protect their future options and allow for a more informed and confident decision.
At ART Surgical, we believe every patient deserves care that is compassionate and respectful of both gender identity and long-term family goals. If you are considering any of these surgeries, our team is here to guide you through every step so you can move forward with clarity and confidence.