Overview

Gender transition can involve hormone therapy and surgery. These treatments can also be called gender affirming hormonal therapy (GAHT) and gender affirming surgery (GAS). Both hormone therapy and surgery can lead to not being able to produce children (sterility).

Your fertility might only be temporarily affected with hormone therapy, meaning that sterility could be reversible. However, this is not guaranteed and can depend on how long you have hormone therapy. Surgery can also lead to permanent sterility.

If you want to naturally produce children, fertility preservation could store some of your reproductive cells giving you an opportunity to use them in the future.

The NHS website has more information about treatment options for gender dysphoria.

Terms we use in this information

As far as possible, we use non-binary biological terms throughout this information to make reading as comfortable for you as possible. However, we know that medical terms can sometimes be more confusing, so we've included the following list that you can use as a guide, if you need to. 

Gonads are circular organs in the reproductive system which contain reproductive cells (gametes). Ovaries and testicles are gonads.

Gametes are reproductive cells in different stages of development in a gonad. Gametes include oocytes (developing eggs in the ovary) and sperm (cells in the testicles).

Embryo is an egg successfully fertilised with sperm to allow potential development of a baby.

Egg collection is a procedure under sedation where the gametes are retrieved. 

Sperm freezing is freezing of ejaculate sperm after masturbation, or surgery in some cases.

When to consider fertility preservation

Although fertility preservation can be considered and discussed at any stage of transition, we generally advise having fertility preservation treatment before any gender affirming therapy.

We cannot offer fertility preservation if you've already had gender affirming surgery to remove both testicles or ovaries (bilateral gonad removal), as this results in permanent sterility.

Discussing fertility preservation while on hormone therapy

You can be referred to the fertility specialist to discuss the options of preserving fertility while on gender affirming hormonal therapy. Based on your individual management so far, the consultant will discuss and advise treatment that is appropriate for you.

A full medical history, screening blood tests, transabdominal ultrasound scan (if you were assigned female at birth) and all the relevant consent forms need to be completed by you before starting treatment.

Stopping hormone therapy temporarily

Currently, there is limited robust data about fertility preservation offered in trans men while on hormone therapy. For this reason, we advise you to consider temporarily stopping hormone therapy for at least 3 months before fertility preservation treatment. Your doctor can help you understand how your reproductive function is affected by hormones and together you can plan your care.

Options for fertility preservation treatment

A full medical history, screening blood tests, and all the relevant consent forms need to be completed by you before treatment is commenced.

Your doctor can discuss each option in detail with you, and give you written information to take away.

Read more about freezing gametes or tissue

Legal information about storing gametes

Under the terms of the Human Fertilisation and Embryology Act (1990), you are required to give written consent about:

1. storage of your gametes
2. the length of time they may be stored for
3. the purposes your gametes can be used for
4. your wishes over any gametes stored
5. what should be done with your gametes in the event of your death, or if you become incapable of changing or cancelling your consent.

If your circumstances change, and you want to update your consent, you must contact us. Please call us on 020 7188 2300 or 020 7188 7188 extension 50426, to arrange an appointment to change your consent forms, or for any further consultations.

NHS funding for fertility preservation

Funding criteria are set by local commissioning authorities known as integrated care boards (ICB). This will be assessed when your doctor refers you for fertility preservation. If you are eligible, funding will be provided for the fertility preservation of your gametes for a specific period of time.

Continued storage after this period may incur a charge. A letter from a NHS gender identity clinic will be required to proceed with fertility preservation. We strive for inclusive care for all patients, and we will support you as much as we can.

Please note that it is not the medical or administrative teams at Guy's and St Thomas' assisted conception unit that make decisions on funding, and we have no authority to grant it.

If you are not eligible for NHS funding

If you are not eligible for NHS funding for fertility preservation, you can still have this treatment with us on a private basis. There will be a charge for consultation, screening tests, treatment cycle, and storage of gametes. Our admin team can give you more information and a price list.

NHS funding for future usage of stored gametes

If you require fertility treatment to achieve a pregnancy, your consultant or GP will have to refer you for assisted conception. At the moment, there is no special funding for fertility treatment for transgender patients. The eligibility criteria for funding are the same as for any other person seeking fertility treatment. If you do not meet these criteria, fertility treatment will have to be self-funded.

Counselling and support

We offer an experienced and confidential counselling service as well as medical treatment, and can arrange a counselling appointment for you.

The Tavistock and Portman NHS Foundation Trust: Gender Dysphoria Clinic for Adults

Phone: 020 8938 7590 or email: [email protected]

HFEA 

UK regulating authority of licensed conception and treatment centres

www.hfea.gov.uk

Infertility Network UK

National charity providing information and counselling for people with fertility issues

www.infertilitynetworkuk.com