For trans and non-binary people considering medical transition, it can be difficult to find the right information about how fertility can be impacted and what treatments are available. We sat down with Asher, who shared their story about embryo freezing, pre-medical transition.

Quick facts:

• Medical transition, depending on the intervention, can impact both male and female fertility. 
• Lots of trans and non-binary people choose to preserve their fertility either before, or during, medical transition. 
• Trans healthcare is incredibly difficult to access and information is scarce. 
• Egg and embryo freezing can be a great option for people assigned female-at-birth to preserve their fertility. 
• More education, conversation and allyship are desperately needed for the trans+ community, especially regarding accessible healthcare.

Fertility concerns for trans+ individuals

Thoughts about fertility may seem very far away when you’re experiencing the distress of having a body that doesn’t align with your identity. 

But for trans and non-binary people considering a physical transition, whether with hormone therapy or gender-affirming surgery, the decisions made before and throughout can have a lasting impact on fertility. 

Trans healthcare can be incredibly hard to access, with waiting lists for NHS Gender Identity Clinics in the UK being an average of 10 years wait or more. 

Educational resources and personal stories of transition can also be hard to find. So we sat down with Asher, who was willing to share their journey with egg freezing to preserve their fertility before transitioning. 

Before we dive into Asher’s story and the important decisions people may need to make around preserving their fertility, let’s understand some important terminology:

• Transgender: A person that has a gender identity or gender expression that differs from the sex that they were assigned at birth. Trans is often used as an umbrella term that can include non-binary people too, but not all non-binary people identify as trans. You don’t have to have medically transitioned to be trans.
• Trans man: A person that has a male gender identity and was assigned female at birth. Transmasc is also a term used for people who have a masculine gender presentation which is different to their assigned sex at birth.
• Transwoman: A person that has a female gender identity and was assigned male at birth. Transfemme is a term used by people who have a feminine gender presentation which is different to their assigned sex at birth.
• Non-binary: A person who has a gender-neutral gender identity.
• Cisgender: A person whose gender identity matches the gender they were assigned at birth.
• They/them/theirs: Gender-neutral pronouns used by people who have a nonbinary, or non-conforming gender identity.
• Gender dysphoria: The distress a person feels due to a mismatch between their gender identity and the gender or sex they were assigned at birth. Gender dysphoria is a diagnosable medical condition that can cause people incredible amounts of discomfort. 

Now let’s meet Asher. After many challenging years of living with gender dysphoria, they were able to access gender-affirming care. Yet it wasn’t until diagnosis and the start of a physical transition, that Asher was made aware of the fertility implications they could face. 

Did anyone along your journey recommend preserving your fertility before undergoing any treatment?

I discovered the importance of this process at the same time I was about to begin physically transitioning — literally the same day I was diagnosed with gender dysphoria and recommended for Testosterone HRT (hormone replacement therapy). 

What were your fears and how did you overcome them?

At the point of discovering this, I had surpassed the tipping point of how long I could cope with the soul-destroying experience of suppressing who I am in order to live in a world that taught me I shouldn’t exist. Managing gender dysphoria and trying to present yourself as something you’re not is an always-on 24/7 painful mask and bodysuit that you can’t take off.

By the time I broke through internal and external barriers and played the arduous waiting game to speak with a doctor, I didn’t want to live another second with that feeling. My whole being was exhausted, terrorised, neglected and desperate for relief.

Hearing then that I should freeze my eggs if I ever want children in the future not only felt like an extra obstacle for something so seemingly distant and intangible. The experience itself also sounded like it would be even more painful than what I’d been living with, as it essentially sounded like it would take me in the opposite direction. 

On top of that, the information felt impossible to make sense of and the whole process itself seemed daunting, uncertain and expensive.

I’ve always known that if life permits I’d love to raise a child someday, but I was totally unable to connect to this purpose. After a few off-putting initial conversations and appointments and my own research, I didn’t think I would be able to cope and was about to walk away. 

Luckily, this is when I was introduced to Hertility and thank goodness I was! Finally some humane guidance, clarity and crucially being seen and understood as a trans person. The whole process became a lot clearer and felt more manageable, and honestly, I started to feel inspired by the gift of being able to do this.

Was it easier than you expected to freeze your embryos?

Yes. Although it wasn’t exactly easy, the actual process wasn’t nearly as bad as I imagined, especially with triggering my dysphoria. I suffered most in the angst-ridden anticipation before speaking with Hertility! It’s all the unknowns and uncertainty that make things feel worse than they are when you just take things day by day.

How did you feel once it was over?

So happy and so grateful. At the offset, I couldn’t have fathomed how joyous it would feel to get through this and know I’d honoured the future parent in me. This feeling only served to enrich how amazing it felt to start my physical transition after.

Do you think we need more awareness in the community about fertility preservation so people know their options prior to gender reassignment surgery? 

Absolutely. I wish I had been more informed and sooner but there was no mention of it, and even when it was it was almost a side-note. Transitioning alone is not an easy, self-determined process so we need to be informed about everything to expect as early as possible to start preparing, mentally and practically. 

Help with gender dysphoria and transition

If like Asher you are living with gender dysphoria and are considering physically transitioning, it is important to understand the implications this may have on your fertility, should you want children in the future. 

Loads of great organisations can help you with the medical, practical and emotional aspects of gender journey and transition including: 

• Gendered Intelligence
• Not a Phase  
• GenderGP