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Planning for the Future

Fertility preservation for transgender people is a reproductive right.

Pixabay
Source: Pixabay

To date, researchers have found that relatively low numbers of transgender and non-binary people are parents. Similarly, recent research suggests that relatively low numbers of transgender and non-binary people choose to preserve their fertility prior to undertaking hormonal or surgical treatments that may negatively impact their fertility.

It is important to ask why this might be so.

With regard to parenting, it is reasonable to suggest that some transgender and non-binary people might prioritize gender transition over reproduction. For other transgender and non-binary people, it might be that genetic reproduction is viewed as potentially distressing, given the normative gendering of gametes. For other people, however, it may be that negative social attitudes towards transgender parents, legislative barriers, and awareness of past practices of the removal of children from parents who disclose that they are transgender or non-binary may prevent some people from having children.

Given these types of barriers, it is vital that all transgender and non-binary people are offered the opportunity of fertility preservation. This may be so that, in the future, decisions can be made about reproduction. It may be that a person already knows they wish to become a parent, but are not yet in a place to fulfill that desire. As has been increasingly recognized, then, fertility preservation is a reproductive right for transgender and non-binary people, and is important for ensuring reproductive justice for them.

At the same time, however, it is important to recognize barriers to fertility preservation for transgender and non-binary people. Key amongst these is cost, with fertility preservation not covered by social health care in countries where social health care exists, and often being prohibitively costly in countries where it does not exist. This would suggest the importance of public coverage of fertility preservation so as to ensure the reproductive rights of transgender and non-binary people.

Another barrier may be the attitudes and competencies of fertility specialists. Experiences or perceptions of misgendering are likely to act as significant barriers to transgender and non-binary people accessing fertility services. Binary gender-segregated services are also likely to be significant barriers. Transgender men, for example, may experience significant marginalization when accessing what are often framed as "women’s services" in regards to reproductive care.

This suggests, then, the importance of inclusive approaches within fertility services. This includes asking about and using the correct pronouns and ensuring that all staff do this; providing separate waiting areas in services that are binary gender-segregated; ensuring that registration forms do not only include binary gender options; and asking patients how they refer to their bodies and using their preferred language. All of these can help to facilitate the inclusion of transgender and non-binary people.

It is also vitally important that legislation is challenged in countries where sterilization is required in order for a person to change their gender marker on their birth certificate. Such legislation still exists in many European countries, in some countries in Asia, and in some states and territories in Australia. Legislation requiring sterilization is a significant barrier to the fulfillment of transgender and non-binary people’s reproductive rights, especially when it is paired with the unaffordability or unavailability of fertility preservation options.

Finally, it is important to recognize that even with the most inclusive and affordable services, some transgender or non-binary people may not wish to undertake fertility preservation. And that is fine. It is important, in working to ensure the reproductive rights of transgender and non-binary people, that it is not expected that all transgender and non-binary people will want to reproduce. Rather, the point is that services should be available, affordable, and inclusive should people want to explore their reproductive options.

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