Fertility preservation for transgender and non-binary people

Hormone therapy and some surgeries change the reproductive system. The NHS gender dysphoria pages state that some treatments may affect fertility and that people can be referred to fertility services to preserve eggs or sperm before treatment. The extent of the effect depends on the treatment, the dose and the duration, and responses differ from person to person.

Not everyone wants children, and the decision about whether to preserve fertility is entirely personal. The purpose of raising it early is that some options are far easier before treatment begins than afterwards, and that it is difficult to reverse a decision made without information.

The regulator outlines four main routes. They apply according to the body parts a person has, rather than their gender identity.

• Sperm freezing: sperm are collected, usually by ejaculation, and frozen. The HFEA describes this as the most effective method of preserving fertility and says it is available from age 13.

• Egg freezing: eggs are collected after a course of hormone stimulation and frozen. The HFEA describes this as a rapidly evolving method.

• Embryo freezing: eggs and sperm are combined to create embryos, which suits couples with embryos they wish to keep.

• Tissue freezing: ovarian or testicular tissue is removed and stored, an option for younger people or those unable to freeze eggs or sperm.

For people with ovaries, egg collection requires several days of hormone injections, monitoring scans and a short procedure under sedation. For some, the injections and the physical changes they bring can cause dysphoria, so clinics experienced in trans care may adapt scheduling, scans and language. People already taking testosterone are commonly advised on whether it must be paused, which is a decision for the specialist, as the timeline varies.

For people with testes, collection of a sample is a quick process but can be distressing for some. Clinics can discuss alternatives, such as surgical collection under anaesthetic. Samples are stored in clinic cryobanks for a defined period under UK law, and consent forms set out how material may be used and what should happen after death, which the HFEA notes clinics must make sure you understand.

Those who have not yet gone through puberty face additional considerations because fertility preservation depends on mature eggs and sperm. Tissue freezing is the option usually discussed for younger people unable to freeze eggs or sperm, and it is an area with specialist, individualised care. Referral routes for under-18s are specialist and subject to change in the NHS, so families should ask the clinical team what is currently available.

The HFEA says NHS coverage varies by location, and that people with a medical reason for preserving fertility, such as cancer or early menopause, may be eligible whereas those delaying family building usually are not. How gender-affirming treatment is treated under local funding policies differs, so the first step is to ask your gender clinic or GP what applies where you live. Private fertility clinics licensed by the HFEA can also provide services, and the regulator publishes information on licensed clinics.

Storage has a continuing cost and a time limit, which a clinic will explain in writing. It is worth asking about the process for extending storage or for withdrawing consent.

Stored eggs, sperm or embryos can be used in treatment such as IUI or IVF, with a partner, with donor gametes or with a surrogate, depending on circumstances. Legal parenthood, birth certificate options and how a clinic records parents have specific rules, so anyone planning to use stored material should seek advice from the clinic counsellor or a family law solicitor.

Some people who start hormones find that fertility returns to a degree if treatment is paused, but this cannot be assumed, and relying on it in place of preservation is not recommended by clinicians. Contraception may still be needed during hormone therapy if pregnancy is possible.

Counselling is available through fertility clinics, and trans-led community organisations often offer peer support. Useful questions include whether the clinic has experience with trans and non-binary patients, how appointments and scans will be handled, what storage costs and time limits apply, and what happens to stored material in future.