Transition can come with huge changes to a trans person’s body, including sterilisation. Trans health specialist Dr Darren Russell spoke with Jesse Jones about how trans folks can have kids.

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Gender transition involves many social and medical choices.

One of the biggest ones can be whether the person transitioning wants to have a family in the future, especially if they’re young.

Hormonal and surgical changes can present challenges for trans people who want to conceive children. Genital or ‘bottom’ surgery in particular usually means sterilisation—the person’s anatomy is altered in a way that involves removing their testicles, ovaries, or uterus.  

Dr Darren Russell is the director of sexual health at Cairns Sexual Health Service. He looks after the health of many trans patients.

“For some odd reason Cairns seems to have more transgender folk than many other regional places,” says Dr Russell.

“We don’t know why that is, but maybe it is just that trans people feel more comfortable being out in Cairns. It is a pretty accepting town on the whole.

“We do see a lot of trans patients in our clinic, and it’s always an honour for people to open up to us so that we can help them as best as we can on their journeys.”

With more young people transitioning these days, Dr Russell is seeing more patients who haven’t yet had their own kids.

“Many years ago when I was working in Melbourne, most of the trans people I saw were older and many of them had already completed having families,” he says.

“It really has been a significant change seeing so many younger trans people.

“Having said that, we only find a small number of younger trans people who really want to have children in the future. Most are not interested at all and are pretty definite about that.”

Dr Russell finds some young trans people want to keep their reproductive options open, and a few are very keen to have kids in the future.

“I always think it’s hard for people in their teens or early twenties to be able to project forward to know what they will want to do in five or ten years’ time—whether or not they are trans—but I think it is important we respect their choices at each stage of their transition,” he says.

How trans people who have started gender transition can have children is a complex issue, but one that doctors can often help with.

“There are many trans guys who have had babies using their partner’s sperm, or donor sperm,” says Dr Russell.

“It is usually just a matter of stopping testosterone for a while and then getting pregnant. Nature usually takes care of the rest.

“The difficulty for the guy, though, lies in actually stopping hormones for such a long time and having periods again and dealing with all those bodily changes—that can be very upsetting for some trans guys.

“For guys who don’t want to do this it is possible to harvest eggs from the ovaries, but this is complex and expensive, unfortunately. These eggs can then be used to produce a baby with the help of a guy’s sperm.”

Trans guys who have had their uterus removed can’t become pregnant, but that could change in the future. Uterus transplants have been done successfully overseas, and Dr Russell says the technology looks very promising.

“They are obviously very complex and won’t be available for some time yet,” he explains.

“An exciting prospect, though.”

Trans women can choose to store sperm before they start hormone therapy.

“This is possible for most of these individuals, though three or more sperm donations can be required,” says Dr Russell.

“This can also be upsetting for a trans woman—having to masturbate to produce sperm which can then be frozen indefinitely.

“There is a cost involved, and each year the sperm is stored costs money, too.

“Once the trans woman starts female hormones the sperm production and quality drop dramatically. Stopping female hormones for several months can lead to sperm being produced again—though this isn’t always successful, unfortunately—but can also be very upsetting for the woman as the testosterone surges back.”

Trans people who may want to have children in the future are usually referred to a local fertility specialist.

“They are very sympathetic and knowledgeable, and can go into the details of what is required, along with the costs and likelihood of success,” says Dr Russell.

“Most reasonable-sized towns will have fertility clinics, and nowadays they are nearly all very suitable for trans people.”

Trans people may be able to access adoption and technologies such as IVF to start their families as well.

It may not be cheap, but with the help of experts it’s definitely possible for trans people to start families.

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