Fertility in transgender women (MtF) can be affected by the hormones they take as part of their transition. Estrogen and androgen blockers can both have a negative impact on sperm production, and in some cases, this damage can be permanent.

If you are an MtF transgender person who is considering hormone therapy, it is important to talk to your doctor about the potential impact on your fertility. You may want to consider sperm freezing before starting hormone therapy, as this will give you the option of having biological children in the future.

Here are some of the ways that hormone therapy can affect fertility in MtF transgender people:


Estrogen can suppress the production of testosterone, which is necessary for sperm production. This can lead to a decrease in sperm count, motility, and morphology.

Androgen blockers:

Androgen blockers, such as spironolactone and finasteride, can also suppress sperm production.

⦁ Orchiectomy:

An orchiectomy, which is the surgical removal of the testicles, will result in permanent infertility.
If you have been taking hormone therapy for a long time, it is possible that you may have already lost some of your fertility. However, it is still worth talking to your doctor about your options. In some cases, it may be possible to recover some of your fertility by stopping hormone therapy or by using assisted reproductive technologies.

Here are some of the options that may be available to you if you want to have biological children after transitioning:

⦁ Sperm freezing:  This is the most common option for preserving fertility in MtF transgender people. Sperm can be frozen and stored for future use.

In vitro fertilization (IVF):  This involves fertilizing eggs with sperm in a laboratory setting. The resulting embryos can then be implanted in the uterus.

Surrogacy:  This involves using a gestational carrier to carry a pregnancy to term. The gestational carrier is not the biological mother of the child.

⦁ MTF (male-to-female): fertility refers to the ability of individuals who have transitioned from male to female to conceive and bear children. It’s important to note that transitioning itself, which typically involves hormone replacement therapy (HRT) and gender-affirming surgeries, can have an impact on fertility.

⦁ Hormone Replacement Therapy (HRT) : for MTF individuals usually involves the use of anti-androgens to suppress testosterone and the administration of estrogen to feminize the body. These hormonal changes can lead to a decrease in sperm production and fertility. However, the extent of fertility reduction varies from person to person, and some MTF individuals may still retain some level of fertility even after undergoing HRT.

⦁ If fertility preservation is a concern for MTF individuals, there are options available to consider before starting HRT or undergoing gender-affirming surgeries. Sperm cryopreservation (freezing sperm) is a common method for preserving fertility in MTF individuals. By storing sperm before starting HRT, there is a possibility of using assisted reproductive technologies, such as in vitro fertilization (IVF) or intrauterine insemination (IUI), to conceive a child in the future.

⦁ It’s important to consult with healthcare professionals, such as endocrinologists, fertility specialists, or reproductive endocrinologists, who can provide personalized advice and guidance based on individual circumstances and goals. They can assess fertility potential and discuss available options for fertility preservation or alternative paths to parenthood, such as adoption or surrogacy, if desired.

⦁ It’s worth noting that fertility options and technologies continue to advance, so it’s always a good idea to seek up-to-date information from healthcare professionals who specialize in transgender healthcare and fertility.