Transgender parents face unique challenges and decisions

At Northwell Health, Randi Goldman, MD, attending physician and the associate fellowship program director in reproductive endocrinology and fertility, regularly sees both trans adults and trans adolescents in her office. “The challenges are knowing what the fertility issues are that trans people can face,” she said. “I recommend that anyone starting gender-affirming treatment be counseled about what it can do to fertility. It’s important to be aware and educated regarding options later in life.”

For starters, “someone thinking of starting gender affirming treatment [hormone therapy to masculinize or feminize] has to make decisions about the risks and benefits in terms of fertility. There’s not a lot of long-term data on whether these medications could cause detrimental consequences later on in life,” said Dr. Goldman.

Similarly, hormone blockers and estrogen will decrease sperm count over time, said the doctor.

“Freezing sperm is an amazing way of providing women [male to female] the ability to have biological children,” said Jovana Lekovich, MD, medical director of Reproductive Medicine Associates (RMA) of New York and director of the oncofertility program and assistant professor of obstetrics, gynecology and reproductive science at Icahn School of Medicine at Mount Sinai.

Also, anyone transitioning to male might want to freeze eggs for options down the road.

Dr. Joshua Safer, executive director of the Mount Sinai Center for Transgender Medicine and Surgery, agreed.

“We in the field need to push it more than we have. Kids aren’t there mentally. Families need to be involved. The more kids show up with mom and dad, the more likely they are to sperm bank,” he said.