When deciding to commence with a chemical transition from male to female, there are many variables to consider. For patients who want or plan to have biological children in the future, taking traditional female hormones—namely estrogen—can pose problems for sperm production. But, does estrogen make MTF women infertile?
The exact effects of estrogen on future reproduction are somewhat unclear. However, estrogen does generally stop sperm production eventually. With that said, some patients have successfully resumed sperm production after stopping hormones for at least three to six months (though the timeline widely varies). There is an extremely small possibility that estrogen could render a transgender woman unable to produce sperm at all. This is an extremely small chance.
Thus, there is a very slight chance that estrogen could make an MTF person infertile. This is rare. However, transgender women have several options for future reproduction if they wish to have biological children someday.
1. Go Sans Hormone Therapy
Not all transgender or non-binary people find it necessary to chemically transition. Some may opt for only physical transition with surgeries like transgender hair restoration. Others may not find any form of transition necessary. In this case, sperm production is not hindered by taking estrogen.
If patients undergo gender affirming surgery with Dr. Sajan, he will likely recommend that they stop taking estrogen for a certain amount of time before surgery. In the case that a patient is not undergoing hormone therapy, this is not necessary.
2. Prepare & Freeze
Freezing sperm is also an option for transgender women who want to have biological children someday and who also want to chemically transition. Therefore, regardless of how MTF hormones affect sperm production, the patient’s gametes are preserved for future use. It is important to note that this option does tend to be rather expensive and is not available to many purely because of this. Patients can discuss this with their hormone prescriber.
3. Consider Other Medications
Depending on the patient’s age, biology, and goals, hormones may not be necessary to chemically transition. For example, patients can take testosterone blockers which will lower testosterone levels in the body and thus uplift estrogen levels. Also, patients can sometimes take smaller doses of estrogen. This will not work for everyone, but can help preserve fertility or even sperm production.
4. Conduct Family Planning
Patients looking to preserve fertility and chemically transition should discuss their future with children with their partners (or reflect on it themselves). For many, having biological children is not a concern. Thus, this opens up options such as adoption and fostering. Revisiting and discussing your plans for the future can help patients better choose the best transition journey for them.
Modern technology has afforded transgender and non-binary people many surgical and non-surgical options for transitioning and living within their true identity. It also reduces the need to make sacrifices in order to transition such as the ability to have biological children. Surgeries like transgender hair transplants can further enhance the results of MTF hormone therapy.