25 Jan 2013

Trans Kids and Reproductive Choices

Trans kids today have new options for transition. Few people even know about these possibilities, although awareness is increasing. In my own pre-teen years, I noticed that my girlfriends were starting to change, and I felt different from them. In my private, inner thoughts, I believed I should be a gay boy, but that seemed so very far from what was possible in reality that I wondered from time to time if I was crazy. I didn't know about the existence of transgender people until I was an older teenager, and even then, I had no idea that trans kids could access any kind of specialized medical help.

Photo: Visit Cape May (Creative Commons)
Hormone blockers have long been used to delay the development of secondary sex characteristics in children experiencing precocious puberty. More recently, paediatricians have started prescribing them for trans kids. This prevents a female-to-male (FtM) trans boy from growing unwanted breasts and experiencing other pubescent changes. In the case of a male-to-female (MtF) trans girl, the blockers halt all the powerful effects of testosterone, including deepening of the voice and changing of the face shape. At age 16 or 18, depending on who you're talking to, patients can begin taking synthetic hormones so that they will develop the secondary sex characteristics of their intended gender, or they can take nothing and develop according to their genetics.

The effects of the hormone blockers are completely reversible. Nevertheless, if an FtM teenager takes them and then takes testosterone as a young adult, his female sexual organs will not mature. I don't know if they would ever mature if he stopped taking the testosterone some years later. Testosterone use in FtM trans guys who transitioned after puberty can cause female sex organs to atrophy, and may also result in polycystic ovary syndrome (PCOS), which can lead to permanent infertility. I haven't been able to find good information concerning its effect on individuals who used hormone blockers and never produced natal hormones.

If I'd known about hormone blockers and the possibility of transitioning earlier in my life, would I have done so? I don't know. I didn't have the social supports necessary for transition at that time. It's hard to separate such a support system from an individual's emotional readiness. I wonder if I may have been much happier earlier in my life if I'd been able to transition as a teenager. I don't know if the choice would have been as clear for me at age 12 or 14 as it was at 23.

If you had asked me when I was ten years old if I thought I would ever want to birth a baby, or even adopt one, I would have for sure said no. At age twenty and even twenty-four, I would have still said no. Nobody asked me. When discussing transition, I don't remember being asked by my therapist, family doctor or endocrinologist if I thought I ever would want to have kids. My surgeon definitely didn't talk to me about future breastfeeding. I'm guessing that most trans people and their health care providers assume that infertility is the price we pay for transitioning. Recently, some people have accused me of wanting to "have it all" – meaning the correct gender identity and my child. Well, isn't that what most others can enjoy?

I didn't contemplate having a relationship and a family until after I'd taken testosterone and had top surgery. I wasn't content enough before that to have any inkling of what I really wanted in that regard. Now, my son and my husband are the most precious parts of my life.

Do I think that trans kids shouldn't take hormone blockers so that they can maintain their reproductive potential? Do I think they shouldn't transition at a young age? No and no. Each individual has to make his or her own decision. Others can guess at how badly someone needs to transition and when, but only the person contemplating transition can really know. Some trans kids suffer from such severe gender dysphoria that they are depressed and even suicidal. These children often feel that they need to transition as soon as possible. Others, like I was, can kind of manage by keeping very busy and not being terribly self-aware – they might not need to transition as urgently.

Sometimes I wish that I could wake up in the morning with a physiologically male body, but I would never trade my baby for anything. Most of the time, I enjoy traveling my unique path. I am comfortable enough with my male-sounding voice, my beard, and my flat chest. The parts of me that I don't love so much are what helped to make the family I love so deeply. This is my conundrum.


  1. I had read that MtF hormone treatment caused irreversible sterility. No? Can you point me to some accurate info on this?

    1. Hi Jake,

      The answer is no, not exactly. If a trans woman suspends her hormone therapy for several months, she may be able to produce viable sperm. In the case that ejaculation is not possible, a fertility clinic may assist with surgical retrieval of sperm. Success is not guaranteed, and it depends in part on how long the woman had been on hormone therapy prior to trying. This is a link to the fact sheet, "Reproductive Options for Trans People" by Rainbow Health Ontario. It provides an overview and cites a number of academic references: http://www.rainbowhealthontario.ca/admin/contentEngine/contentDocuments/Reproductive_Options_for_Trans_People_final.pdf

      Hope that helps!


  2. Beautiful, thoughtful post on a very complex issue. Bravo Trevor, we need more voices like yours out there.

  3. Thank you. I loved this post and am enjoying your blog immensely.

  4. Thanks for posting such a great post. I don't really look to many people as a rolemodel, but I really hope I can follow in similar footsteps; your story is really inspiring and well... pretty much everything I hope to have in my future. Keep it up!

  5. For what it's worth, prior to going on hormones I *was* counseled on reproductive options. As it turned out, I'd already reproduced, so this wasn't an issue for me, but I'm glad my clinic addressed the issue directly instead of just assuming I was OK with the possibility of infertility. I've spent a fair amount of time trying to understand my pregnancy in the context of my gender identity, so this quote definitely hit home: "Sometimes I wish that I could wake up in the morning with a physiologically male body, but I would never trade my baby for anything."

  6. A really interesting post. I got linked to your blog this morning and I think I've found a new regular blog to read :)

    I was just wondering if you had any more references about trans men and PCOS? I've got PCOS and I'm told my testosterone levels (unusually high for a woman) make it worse, thus the treatment is birth control pills to try to regulate hormones and make them more 'normal', and it just popped into my head a few weeks ago that what would trans men be able to do for PCOS, short of surgery that they may not want. Then again, I may be mis-informed about the affects of testosterone on PCOS - in my experience doctors don't always explain conditions properly.