Q: Does testosterone cause infertility?
A: Though testosterone therapy may stop your period, research suggests that testosterone has no known negative affect on the overall health or long-term fertility of one’s eggs (Light et al. 2014). This is why many reproductive health care experts will tell you that testosterone should not be used as a replacement for birth control. However, testosterone use may thin the lining of the uterine wall, making it much more difficult yet not impossible for one to become pregnant. Those who use lower doses of testosterone or those who many not follow a routine schedule (missing or skipping doses) may be more likely to accidentally become pregnant if not on birth control (Charlton et al. 2020). Continued testosterone use during pregnancy may result in developmental abnormalities of the fetus, and may result in miscarriage. Because of this, providers often recommend that those seeking to intentionally become pregnant should develop a plan to wean off of hormone replacement therapy before attempting to become pregnant, preferably after allowing menstruation to return which usually happens within six months of stopping testosterone. Research indicates that prior testosterone use has not been found to affect reproductive outcomes, nor does it necessarily suggest higher rates of pregnancy loss when compared to cisgender women (Leung et al. 2019) (Riggs et al. 2020). Visit our Readings & Viewings page for further resources and information on transmasculine fertility and reproduction.
Q: What do I do if I experience vaginal atrophy?
A: The decrease and thinning of vaginal muscles (also known as vaginal atrophy) is a condition caused by testosterone use. It can make vaginal penetration uncomfortable or even painful, and may lead to tearing or bleeding. However, this is a treatable condition (Mayo Clinic, 2021). One of the most common treatments is the use of vaginal moisturizers or water-based lubricants to ease discomfort. Dilation, a form of exercise which can help rebuild vaginal muscles, is also an option. Topical estrogen and medication are also available. Talk to your doctor about what is right for you!
Q: Does testosterone cause polycystic ovary syndrome (PCOS) or make it worse?
A: Polycystic ovary syndrome is a condition in which numerous small cysts develop on the ovaries. This condition has been known to increase the risk of infertility. The exact cause of PCOS is unknown. While limited research exists, one study found that testosterone use in trans men across a wide range of doses and over many years did not have correlation with causation or exacerbation of PCOS (Chan et al. 2018). If you are experiencing PCOS, talk to your doctor about a treatment that is right for you.
Q: What are my options if I don’t want to be pregnant but still would like to expand my family?
A: Luckily, many options are out there for those who aren’t interested in becoming pregnant but would still like to have children. One option for those who would rather not become pregnant is to find a surrogate who is willing to carry the pregnancy for you, whether that be a partner, family member, or even a stranger. Some individuals prefer that surrogates become pregnant through the process of IVF. IVF, or in vitro fertilization, is a technique in which eggs are removed from a person’s ovaries and fertilized with sperm in a lab before being implanted in an individual’s womb.
For more fertility resources relating to surrogacy and IVF, check out our Fertility Centers & Health Care resource page. Another great option to expand your family is through adoption. Recourses on adoption can be found in our Family Centers, Support Groups & Webinars resource page. Visit our Reproductive Education & Training page for more informative resources on fertility and family building. For more information on queer and trans family rights and law, visit our Legal Resources page. For conferences designed to educate and empower queer family building, visit our Conferences page. Visit our Readings & Viewings page for further resources and information on transmasculine fertility and reproduction. To hear the story of a trans man who was able to use his own eggs along with donor sperm to impregnate his partner, check out his oral history here!
Q: What are my options if neither my partner nor I produce sperm but would like to become pregnant?
A: Thankfully, reproductive options for individuals who don’t produce sperm have come a long way! Sperm donation involves the process of finding an individual who produces sperm and gaining their consent to use it in order to become pregnant. Often, people seek out sperm banks to find donor sperm, but donors can be found outside of clinical institutions as well. For those who feel uncomfortable with performing sexual intercourse in order to become pregnant, either IVF (in vitro fertilization) or IVI (at-home insemination) are great options. The Mosie IVI kit is an option championed by Trans Fertility Co.
For resources on sperm donation and IVF, please visit our Fertility Centers & Health Care resource page. Visit our Reproductive Education & Training page for more informative resources on fertility and family building. For more information on queer and trans family rights and law, visit our Legal Resources page. For conferences designed to educate and empower queer family building, visit our Conferences page. Visit our Readings & Viewings page for further resources and information on transmasculine fertility and reproduction. In this article clipping from 1982, you can learn about a trans man and his partner who sought out strangers to help them expand their family through sperm donation. Note that some of the language used in these clippings are outdated and may be upsetting to some, and so discretion is advised. To hear the story of a trans man who was able to use his own eggs along with donor sperm to impregnate his partner, check out his oral history here!
Q: Does PrEP (pre-exposure prophylaxis) or ART (antiretroviral therapy) affect fertility?
A: In a study of women who received ART (antiretroviral therapy), roughly 1/7 of whom were receiving regimens that contained TDF (tenofovir disoproxil), it was found that those taking TDF had slightly lower fertility rates than those who did not (Mugo et al. 2014). In a study of participants who did not have HIV but whose sexual partners had HIV, taking TDF or TDF/FTC (fumarate/emtricitabine) did not significantly affect fertility rates (Maskew et al. 2012). In another study, individuals taking dolutegravir during the process of conception were found to have an increased risk of developmental defects in their infants. However, these developmental risks were found to be low in frequency (Zash et al. 2018). If you are on PrEP or ART and wanting to become pregnant, or are considering starting PrEP or ART before attempting to conceive, talk to your doctor about what is right for you. For more information, visit the United States Government’s website on clinical information relating to HIV.
Q: Where can I find support around my fertility?
A: For resources offering clinical care relating to fertility, please visit our Fertility Centers & Health Care resource page. For emotional and educational support regarding the process of becoming pregnant, visit our Family Centers, Support Groups & Webinars resource page. For more options regarding clinical, non-clinical, and emotional support, visit our Directory of Trans-Affirming Care. Visit our Readings & Viewings page for further resources and information on transmasculine fertility and reproduction.