Family creation: information on reproductive planning

Many trans people may be interested in becoming parents and having children. There are several ways to become a parent, including pregnancy, surrogacy, adoption, or fostering.

• Parenting options for 2SLGBTQ people — General information about parenting options for 2SLGBTQ people and families. Includes a discussion of adoption, surrogacy, and parenting in community. 

Planning for reproduction

If you think you may want to have children now or in the future, discussing this with your health care provider early in your journey will help you align your parenting goals with your gender-affirmation The ways a person can be supported in expressing their self-identified gender. This may involve supporting social transition steps or changes in gender expression. goals. Starting hormones or having lower surgery Umbrella term for gender-affirming surgeries done below the waist, including hysterectomy, erectile tissue release, metoidioplasty, phalloplasty, orchiectomy and vaginoplasty surgeries. Also called “bottom surgery”. does not change your ability to become a parent but it may limit the reproductive options available to you. 

Every person has a unique journey in their decision-making and planning around reproduction. Some individuals may choose to pursue hormone therapy or surgery before reproductive planning, and others may decide to postpone this care until they have a reproductive plan in place. 

Discuss your thoughts about reproductive planning with your partner, family or care provider. These conversations may help clarify available options, including costs and timelines related to reproductive cell preservation and how these options may be impacted by medical or surgical gender-affirming care Processes through which a health care system cares for and supports an individual while recognizing and acknowledging their gender and expression. decisions. 

• Reproductive options for trans people — Provides information about reproductive options for trans people interested in hormone therapy or gender-affirming surgeries.

Preserving reproductive cells

Unfortunately, B.C.’s Medical Services Plan (MSP The Medical Services Plan (MSP) is a B.C. government health plan that pays for physician services and referred services that are considered medically necessary, such as specialists (surgeon, psychiatrist, etc.), diagnostic x-rays, or laboratory services, for all BC residents. Some residents qualify for premium assistance for physiotherapy, chiropractic, naturopathy, massage therapy and acupuncture. ) does not cover the cost of fertility treatments. If you have private insurance, you may have some coverage, otherwise you will need to pay for this treatment.  

• Assisted human reproduction options and funding available across Canada — An overview of funding options and the approximate costs for fertility related health care for people across Canada. 

Sperm

Taking estrogen-based hormone therapy may decrease sperm count. This may or may not be reversible after stopping  medications. 

The processing fee for sperm can range between about $200–$700. The storage costs are about $200 per year.

• Fertility preservation for trans people who produce sperm — Designed to help transgender, Two-Spirit A term used within some Indigenous communities to reflect complex Indigenous understandings of gender and sexuality and the long history of sexual and gender diversity in Indigenous cultures. Two-Spirit encompasses sexual, gender, cultural and spiritual identity. It may refer to cross-gender, multi-gender or non-binary gender roles, non-heterosexual identities, and a range of cultural identities, roles and practices embodied by Two-Spirit peoples. Some people also use "2-Spirit" or "2S." (Source: Battered Women’s Support Services) , and non-binary Umbrella term referring to people whose gender does not fall within the binary gender system of woman/girl or man/boy. Some individuals identify as non-binary while others may use terms such as gender non-conforming, genderqueer, or agender. Non-binary people may or may not conform to societal expectations for their gender expression and gender role, and they may or may not seek gender-affirming medical or surgical care. people who produce sperm to understand their assisted reproductive options. 

Eggs

Retrieving eggs requires multiple visits with a fertility specialist. This usually involves stopping testosterone (if you are taking it) and taking injectable medications for 10–14 days to increase your egg count. You will then undergo a procedure to retrieve the eggs from your internal gonads (ovaries). This procedure is done under sedation and involves a pelvic exam. 

The cost for this procedure can range between $10,000–$14,000. Once removed, the eggs are frozen and can remain frozen for years. 

• Fertility preservation for trans people who produce eggs — Designed to help transgender, Two-Spirit, and non-binary people who produce eggs to understand their their assisted reproductive options. 

Choosing a provider

You can ask other trans people for recommendations for a fertility clinic. Feel free to contact the Trans Care BC health navigation team for recommendations of clinics or providers in your area. We will do our best to connect you with someone.

When choosing a clinic or care provider, you might want to ask them about their experience with trans patients, including:

• How many trans patients have you treated?
• What does your clinic do to be safer for trans patients?

You can also take a look at their office or clinic waiting room to see if they have inclusive materials or review their forms to see if they are gender inclusive.

Testosterone & pregnancy 

Many trans, Two-Spirit, and non-binary people capable of becoming pregnant take testosterone to affirm their gender. Testosterone is considered unsafe in pregnancy and should be stopped if you are pregnant or trying to get pregnant. If you get pregnant while on testosterone, it is recommended to stop testosterone and see your primary care provider A person’s main health care provider in non-emergency situations such as check-ups and referrals. Family doctors, general practitioners (GPs) and nurse practitioners (NPs) are all primary care providers. .

Additional resources

Once you become a parent, you may want some additional resources on this new life phase. Visit our section for Trans Parents for more information.

• Preconception health for 2SLGBTQ people — A resource for 2SLGBTQ people who are planning to become parents through pregnancy, including supporting a partner, co-parent or surrogate’s pregnancy. 

Credit: Rainbow Health Ontario

Resources linked on this page were developed by Rainbow Health Ontario through a project called Improving the Quality and Access of Sexual and Reproductive Healthcare for 2SLGBTQ People Living in Canada.