Trans and Nonbinary Family Building: Fertility Options and What to Know
Building a family as a trans or nonbinary person is absolutely possible, and more people are doing it than ever before. But the path often involves navigating medical questions, emotional complexities, and logistical hurdles that cisgender families rarely encounter. If you are exploring your fertility options, whether you are years away from wanting children or ready to start now, this guide is here to give you clear, compassionate, evidence-based information so you can make decisions that feel right for your body and your future family.
We recognize that fertility and reproduction can be deeply personal and sometimes complicated terrain for trans and nonbinary people. Conversations about reproductive organs and hormones can trigger dysphoria, and the medical system is still catching up when it comes to providing affirming, knowledgeable care. You deserve information that is honest, respectful, and grounded in the best available science. That is what we aim to provide here.
Understanding How Hormones Affect Fertility
The relationship between gender-affirming hormone therapy and fertility is one of the most common questions, and one of the most important to understand clearly. The effects differ depending on the type of hormone therapy.
Testosterone and Fertility
For transmasculine and nonbinary people taking testosterone, the hormone suppresses ovulation and typically causes menstruation to stop. During active testosterone use, natural conception is unlikely, though not impossible. Some people have conceived while on testosterone, which is why contraception is still important if pregnancy is not desired.
The critical question most people ask is whether testosterone permanently affects the ability to get pregnant later. The current evidence is largely reassuring. Research, including studies referenced in the WPATH Standards of Care, indicates that many transmasculine people who discontinue testosterone regain ovulatory function and can conceive. Menstrual cycles typically resume within 2-6 months after stopping, though individual timelines vary.
However, there are important caveats. Long-term testosterone use may reduce ovarian reserve over time, and not every person who stops testosterone will see full return of fertility. The research base is still growing, and long-term studies with large sample sizes are limited. For this reason, fertility preservation before starting testosterone is recommended for anyone who thinks they may want biological children in the future.
Estrogen and Fertility
For transfeminine and nonbinary people taking estrogen, the hormone significantly reduces or stops sperm production. The longer estrogen is used, particularly in combination with anti-androgens, the more likely it is that sperm production will be substantially or permanently reduced. Some people who discontinue estrogen see partial recovery of spermatogenesis, but this is not guaranteed.
The American Society for Reproductive Medicine recommends fertility preservation before initiating estrogen therapy for anyone who may want biological children. Sperm banking is straightforward, relatively affordable, and provides a reliable path to biological parenthood regardless of what happens to natural sperm production during hormone therapy.
Fertility Preservation: What to Know Before Starting HRT
Fertility preservation is, in many ways, the single most important decision point for trans and nonbinary people who want biological children. The options and their effectiveness are heavily influenced by timing.
Egg and Embryo Freezing
For people with ovaries who plan to start testosterone, egg freezing (oocyte cryopreservation) or embryo freezing before beginning HRT preserves the highest-quality eggs. The process involves ovarian stimulation with injectable medications over approximately 10-14 days, followed by an egg retrieval procedure under sedation. Retrieved eggs can be frozen unfertilized or fertilized with sperm to create embryos before freezing.
This process requires interaction with reproductive organs and hormonal stimulation that may feel uncomfortable or dysphoria-inducing. Working with a clinic that has experience with transgender patients and can provide affirming care makes a significant difference. Some clinics offer modified protocols or support strategies to help manage dysphoria during the process.
Cost typically ranges from $8,000 to $15,000 per cycle, plus annual storage fees of $500-$1,000. Insurance coverage is expanding, with several states now mandating coverage for fertility preservation when medically necessary, including for transgender patients. Organizations like the Family Equality Council maintain resources on financial assistance and grants.
Sperm Banking
For people with testes who plan to start estrogen, sperm banking is a simpler and more affordable preservation option. It involves producing semen samples through ejaculation, which are then frozen and stored at a cryobank. Most facilities recommend banking 3-5 samples to ensure adequate supply for future use.
Sperm banking should ideally be completed before starting any estrogen or anti-androgen therapy. If you have already begun HRT, it may still be possible to bank sperm after temporarily pausing hormones, though sperm quality and quantity may be reduced compared to pre-HRT levels.
Costs typically run $500-$1,000 for the initial banking process, plus $200-$500 per year for storage. While less expensive than egg freezing, it is still a meaningful investment that provides invaluable insurance for future family building.
Conception Paths for Trans and Nonbinary People
The path to conception depends on your anatomy, your partner's anatomy (if applicable), whether you have preserved gametes, and how you want to build your family. Here are the most common paths.
Carrying a Pregnancy After Testosterone
Transmasculine and nonbinary people who wish to carry a pregnancy will need to discontinue testosterone, typically 3-6 months before attempting conception. During this time, the body gradually returns to its pre-testosterone hormonal patterns, ovulation resumes, and conception becomes possible.
This process can be emotionally complex. Returning to a hormonal state you may have worked to change, experiencing the return of menstruation, and navigating pregnancy in a body that may not feel fully aligned with your identity are all real challenges. Finding a supportive healthcare team, connecting with other trans parents who have walked this path, and having access to mental health support can make an enormous difference.
For conception itself, at-home insemination offers a private, comfortable option that many trans and nonbinary people prefer over clinical settings. The BabyMaker is designed with comfort as its primary focus, using soft, smooth, medical-grade silicone that is gentle and easy to use. For those using frozen sperm from a bank or from previously banked samples, the CryoBaby is specifically designed for frozen and low-volume samples. Our guide to getting pregnant without sex covers every method in detail.
Using Preserved Sperm
Transfeminine people who banked sperm before starting estrogen can use those samples for insemination or IVF with a partner who can carry, or with a gestational surrogate. If using at-home insemination with a partner, our guide to thawing frozen sperm covers the process step by step, including how to handle cryobank vials at home safely and effectively.
Using Donor Gametes
If fertility preservation was not completed before HRT, or if natural fertility has not returned after pausing hormones, donor gametes provide another path. Donor sperm is available through licensed cryobanks, and donor eggs can be obtained through fertility clinics. Our guide to understanding sperm donor profiles helps you navigate the selection process.
Adoption and Surrogacy
Not every trans or nonbinary person wants to conceive biologically, and that is completely valid. Adoption and surrogacy are established family-building paths. Surrogacy involves a gestational carrier who becomes pregnant through IVF using your embryos (created from your own or donor gametes). Adoption has its own legal and emotional landscape that varies significantly by state and agency. Both paths create families that are no less real or meaningful than those built through biological conception.
Finding Affirming Healthcare Providers
The quality of your experience will be heavily influenced by the providers you work with. Seek out reproductive endocrinologists, OB-GYNs, and midwives who have specific experience working with transgender and nonbinary patients. Signs of an affirming provider include using correct pronouns and chosen names, asking about your preferences for terminology around body parts, having intake forms that include gender identity options beyond the binary, and being knowledgeable about how HRT affects fertility without requiring you to educate them.
The WPATH provider directory, LGBTQ+ health centers, and word-of-mouth recommendations from trans community networks are good starting points for finding affirming care. Our guide to privacy and discreet shipping also covers how to maintain confidentiality throughout your family-building process if that is important to you.
Legal Considerations
Legal protections for trans and nonbinary parents vary dramatically by jurisdiction. Depending on where you live, you may need to navigate birth certificate amendments, parentage orders, second-parent adoption, or other legal processes to ensure both parents (if applicable) have recognized legal rights.
If using a known sperm donor, a comprehensive donor agreement is essential. Our guide to known donor agreements covers what should be included and why legal documentation matters regardless of your relationship with the donor. A reproductive law attorney with LGBTQ+ family law experience is strongly recommended.
Emotional Support and Community
The emotional dimensions of family building as a trans or nonbinary person deserve just as much attention as the medical and legal logistics. Pregnancy, fertility treatment, and the TTC process can all interact with gender identity in ways that are sometimes joyful and sometimes challenging.
Connecting with other trans and nonbinary parents and prospective parents can provide support, validation, and practical wisdom that no clinical guide can replicate. Online communities, local LGBTQ+ parenting groups, and organizations like Family Equality offer spaces where your experience is understood and affirmed. Therapy with a provider who is knowledgeable about both gender identity and reproductive mental health can also be invaluable.
Your desire to become a parent is valid. Your identity does not limit your right to a family. And the paths available to you, while sometimes more complex than those available to cisgender people, are real, proven, and within reach. For a broader look at all the family-building options available to LGBTQ+ individuals and couples, our comprehensive guide to LGBTQ+ family building covers every path in detail.
Frequently Asked Questions
Can you get pregnant after testosterone?
Yes, many transmasculine people have successfully conceived after discontinuing testosterone. While testosterone suppresses ovulation during use, it does not permanently destroy ovarian function in most cases. After stopping testosterone, menstrual cycles typically resume within 2-6 months, though the timeline varies by individual and duration of use. Research shows that people who have used testosterone can conceive, carry healthy pregnancies, and deliver healthy babies. However, long-term or high-dose testosterone use may affect ovarian reserve over time, so discussing your specific situation with a fertility-aware healthcare provider is important.
Does estrogen affect sperm production permanently?
Estrogen therapy significantly reduces or stops sperm production during use, but the effects are not always permanent. Some transfeminine people who discontinue estrogen see partial or full recovery of sperm production, while others experience lasting changes. The likelihood of recovery depends on several factors including duration of use, dosage, whether anti-androgens were also used, and individual biology. Current research suggests that the longer estrogen has been used, the less likely full recovery of sperm production becomes. This is why fertility preservation through sperm banking before starting estrogen is strongly recommended for anyone who may want biological children in the future.
Do I have to stop HRT to get pregnant?
For transmasculine people taking testosterone who wish to carry a pregnancy, yes, testosterone must be discontinued before conception and throughout pregnancy, as it can cause harm to a developing fetus. Most providers recommend stopping testosterone at least 3-6 months before attempting conception to allow ovulation to resume and hormonal levels to stabilize. For transfeminine people taking estrogen who wish to produce sperm for conception, estrogen typically needs to be paused to allow sperm production to resume, though the timeline for recovery varies. Any changes to HRT should be made under the guidance of your prescribing provider, who can help manage the physical and emotional aspects of pausing hormone therapy.
What fertility preservation should I consider before hormones?
For transmasculine and nonbinary people with ovaries, egg freezing or embryo freezing before starting testosterone preserves the highest-quality eggs for future use. This involves ovarian stimulation and an egg retrieval procedure. For transfeminine and nonbinary people with testes, sperm banking before starting estrogen is simpler and more affordable, requiring only producing and freezing semen samples. Both options are most effective when done before any hormone therapy begins, though they can sometimes be pursued after pausing HRT. The cost of fertility preservation varies, with sperm banking typically running $500-$1,000 plus annual storage fees and egg freezing costing $8,000-$15,000 plus storage. Some insurance plans now cover fertility preservation for transgender patients, and grants are available through organizations like Family Equality.
Explore Your Options
Take our 30-second quiz to find the insemination kit designed for your specific situation.
Find Your Kit