by Flora Ocean Parkin
As I hurtled through my closeted twenties, fuelled by Lucozade, live music and identity-confusion, rarely did I consider whether I wanted children later in life. Like many other trans people before transition, I simply couldn’t comprehend a future for myself beyond the months ahead. Trying to ignore the knotty complexity of my sexuality and gender, I instead stuffed my present full of projects, thrill seeking and distractions. As my 27th birthday came and went, I gradually opened up, learned the words to express what I felt inside, and came to terms with my trans queer self. A future that previously seemed incomprehensible began to enter my sightlines, and I eventually came out as a trans woman.
What I didn’t see coming, was the warm glow of maternal desire I’ve felt in my body since turning 30. I’ve not medically transitioned, and the visceral depth of these feelings has taken me by complete surprise. This has stirred up contrasting feelings for me: gender euphoria, logistical apprehension, bodily dysphoria, and moments of heartbreak. To make sense of this head-spinning combination, I turned to the internet, trawling online for experiences like mine. For all my scrolling, the accounts I could find were few and far between.
While studies in the US show trans adults wanting to become parents as much as their LGBTQ+ peers, international studies into fertility preservation rates in trans women offer limited, conflicting data (for example, https://www.familyequality.org/2019/10/02/trans-women-and-fertility-what-we-know-what-dont-know-and-what-you-can-do/ and https://www.bionews.org.uk/page_149069). In the UK where there is less research, several general factors could limit conversations about family planning for trans people. Disproportionate mental health challenges, medical discrimination, and a notoriously overstretched NHS with limited access to necessary services could make it harder for trans people to feel supported in considering pathways to having a family (you can read about it here, here, here, here, here and here). On a more basic level for trans young people, family planning can seem remote and secondary whilst navigating the jarring experiences of puberty.
But there are established pathways for trans people of all genders to have genetically-related children. Here I want to share what I’ve found about routes to parenthood for trans women, as a trans woman. Hopefully this information can contribute to a conversation about maternal desire that other trans women might relate to.
Before starting HRT, the standard clinical advice to trans women is to bank your sperm ahead of medically transitioning. This is to enable trans women to use their sperm when conceiving a child with a future partner through assisted conception techniques, such as IUI, IVF and egg donation, depending on your partner (or surrogate)’s circumstances (more info on that here). This is encouraged because HRT can reduce fertility in trans women (e.g. lessening the amount, quality and motility of the sperm produced, and affecting erectile performance). While private sperm banking options can be prohibitively expensive, some local NHS services do provide fertility preservation for those planning to medically transition (for example Manchester University NHS Foundation Trust and Nottingham University Hospitals).
However it isn’t understood exactly how HRT affects fertility in trans women, largely due to a lack of research. There is the possibility that medically transitioning trans women could pause their HRT in order to regain their fertility to either bank their sperm or impregnate their partner should they have a womb. However this is not well researched. Surgical changes like bottom surgery, where the testes are removed, make it no longer possible for trans women to bank or use their sperm.
For trans women that do surgically transition, there are exciting developments in fertility and embryology that could enable the experience of pregnancy through uterus (womb) transplants in the near future. The first womb transplants for cis women have now been successfully delivered, with children born from transplanted wombs in Brazil and Sweden in recent years. Founder of London Transgender Clinic, Mr. Inglefield, has since commented on the achievability of providing equivalent womb transplants for trans women too. Supplemented by additional hormones to replicate those produced naturally in cis women during pregnancy, pregnant trans women could conceivably then deliver babies via caesarean section. There are however, legal ambiguities around the creation of embryos for use by trans people, something that is currently illegal in the UK.
There are of course, many different ways of experiencing parenthood that go beyond pregnancy and genetically-related family, such as adoption. But there shouldn’t be an expectation that trans people have to sacrifice the experience of raising genetically-related families as a cost of medical and surgical transition. Desiring one’s own children is a universal human experience, and one trans people are no less deserving of than cis people.
Hopefully in the years to come, we’ll see trans people of all genders granted access to the medical and surgical support they need to experience the joys of having genetically-related children, regardless of the body they were born with. That is a future I can see clearly now, and one in which I would love to live.