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Verywell Mind's content is for informational and educational purposes only. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment.
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Elizabeth Boskey, PhD, MPH, CHES, is a social worker, adjunct lecturer, and expert writer in the field of sexually transmitted diseases.
Susan Olender, MD, is an assistant professor of medicine at Columbia University College of Physicians and Surgeons in New York City.
Individuals are considered to be transgender if their gender identity does not align with the gender associated with the sex they were assigned at birth. Many transgender individuals choose to socially and/or medically transition so that their gender presentation aligns with their gender identity.
Socially transitioning usually involves dressing and presenting in a way that fits with the person's gender identity. Medically transitioning can involve taking hormones, surgery, or both.
Not all individuals choose to medically or surgically transition. However, those who do may face a dilemma: What do they do if they want to have children later? Both hormone treatments and surgery can impact fertility. Some surgeries, such as the removal of the ovaries or testes, result in permanent infertility11
Research has shown that around half of transgender adults regret their inability to have children after they transition.2 This has led to the recommendation that health care providers discuss fertility issues with all transgender people before they start to transition.
However, these discussions don't always happen. In addition, even when they do, the need to transition can be overwhelming enough to make other concerns seem unimportant. That's particularly true for concerns like fertility, that may not be relevant until later in life.
For some people, the inability to have their own genetic children is not an issue—they may not be interested in having a family or they may want a family but not care about whether their children are biologically related to them. For others, however, the ability to have biological children is important to their long-term happiness. That's where fertility preservation comes into play.
Transgender men and transmasculine individuals who transition after puberty have several options for fertility preservation. Specifically, individuals can undergo egg stimulation and harvesting—similar to that for an IVF procedure.1
However, for many transgender men, this option can increase dysphoria—discomfort in their bodies. They may not feel comfortable taking a large amount of hormones to stimulate their ovaries. In such cases, there is the possibility of ovarian tissue harvesting. However, it is less effective than ovarian stimulation.
It is worth noting that transgender men and transmasculine people who do not have bottom surgery can get pregnant.3 If they keep their ovaries and uterus, it is possible for them to experience a healthy pregnancy. However, in order to do so, they need to stop taking testosterone for the duration of the pregnancy. They also need access to either sperm or a fertilized ovum.
Fertility preservation for transgender women is easy if it is done before they start taking estrogen.4 Sperm banking is relatively simple and affordable. However, for some women, the need to masturbate and ejaculate can be too dysphoric. For these women and transfeminine folk, it's possible to either stimulate ejaculation electrically or to use surgery to harvest sperm directly from the testicles.
When transgender adolescents are identified before puberty, it can be an incredibly positive thing for them. The standard of care has become using puberty blockers to halt puberty until teenagers and their families are ready.5
Then, the teenager can either stop taking blockers to resume the puberty associated with the sex they were assigned at birth or start using hormones pills and/or injections. Either way, the teenager only has to go through puberty once. They don't have to go through a puberty that may be upsetting or painful. They also are more likely to be able to conform to visible gender expectations as an adult.Unfortunately, the downside of puberty blockers is that transgender adolescents who take them have reproductive tracts that do not fully mature.6 That means that young transgender women can't provide sperm and young transgender men can't provide eggs. In order to do so, they would need to go further through the puberty that blockers are designed to prevent.
There are some experimental options that have been pioneered in young cancer patients whose fertility is also often affected by medical treatment. Ovarian or testicular tissue can be harvested and frozen.7 Then, at a later date, it may be possible to use hormones to mature that tissue and provide viable eggs and sperm.
The efficacy of these techniques is not something that young people can count on. However, it may be a worthwhile option for adolescents who think they might want to have children and can afford the procedures.
A significant number of transgender people have children before they transition, particularly when they transition later in life. As a whole, their children are as happy and healthy as children of cisgender couples.8 That's true for couples who divorce as well as couples who stay together.
One of the biggest factors in children's adjustment is whether their parents continue to have a good relationship. It is also often easier for children to adjust to a parent's transition earlier in their life.
No matter when a parent transitions, their whole family will likely benefit from support. It's a big change for the transgender parent's life, but also for the lives of those who love them. Seeking out resources such as family therapy with a transgender-affirming therapist, or transgender parenting support groups (in person or online), can be incredibly helpful.9 
If you are seeking support for issues with coming out, relationships, bullying, self-harm, and more, contact the LGBT National Hotline at 1-888-843-4564 for one-to-one peer support.
For more mental health resources, see our National Helpline Database.
Learn the best ways to manage stress and negativity in your life.
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Cheng PJ, Pastuszak AW, Myers JB, Goodwin IA, Hotaling JM. Fertility concerns of the transgender patient. Transl Androl Urol. 2019;(8)3:209-218. doi:10.21037/tau.2019.05.09
Mitu K. Transgender reproductive choice and fertility preservation. AMA J Ethics. 2016;(18)11:1119-1125. doi:10.1001/journalofethics.2016.18.11.pfor2-1611
Babayev SN, Arslan E, Kogan S, Moy F, Oktay K. Evaluation of ovarian and testicular tissue cryopreservation in children undergoing gonadotoxic therapies. J Assist Reprod Genet. 2013;(30)1:3-9. doi:10.1007/s10815-012-9909-5
Bockting W, Coleman E, Deutsch MB, et al. Adult development and quality of life of transgender and gender nonconforming people. Curr Opin Endocrinol Diabetes Obes. 2016;23(2):188-197. doi:10.1097/MED.0000000000000232
Dierckx M, Motmans J, Mortelmans D, T'sjoen G. Families in transition: A literature review. Int Rev Psychiatry. 2016;28(1):36-43. doi:10.3109/09540261.2015.1102716
Light AD, Obedin-Maliver J, Sevelius JM, Kerns JL. Transgender men who experienced pregnancy after female-to-male gender transitioning. Obstet Gynecol. 2014;124(6):1120-7. doi:10.1097/AOG.0000000000000540
McCracken K, Nahata L. Fertility preservation in children and adolescents: Current options and considerations. Curr Opin Obstet Gynecol. 2017;29(5):283-288. doi:10.1097/GCO.0000000000000395
Webster CR Jr, Telingator CJ. Lesbian, gay, bisexual, and transgender families. Pediatr Clin North Am. 2016;63(6):1107-1119. doi:10.1016/j.pcl.2016.07.010
Wierckx K, Van Caenegem E, Pennings G, et al. Reproductive wish in transsexual men. Hum Reprod. 2012;27(2):483-7. doi:10.1093/humrep/der406
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Eating Disorders in Transgender People
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Parents say they feel free, but children take time to adjust to new gender.
Transgender Miss Universe Finalist Disqualified
Miss Universe Canada contestant Jenna Talackova, 23, was born a man.
March 27, 2012— -- When Sabine Bartlett was 13 her mother, who had been divorced from her father for a decade, transitioned from female to male.
Even though Sabine had grown up in a Unitarian Church with lots of gender and sexual diversity, Sabine knew little about being transgender.
Now 16 and living in Somerville, Mass., Sabine remembers her mother was "never particularly feminine," but began to "present as more butch."
"I came home from a trip with to my Dad's house and mom sat me down on the couch and told me she was going to transition," she said. "It's hard to face the fact that someone who is close to you changes at all -- especially a change that big."
An estimated 750,000 Americans identify as transgender -- about .3 percent of the population, according to the Williams Institute, an LGBT think tank at the UCLA Law School.
A National Transgender Discrimination Survey of nearly 6,000 respondents revealed that about 38 percent were parents and at least 18 percent had at least one dependent child.
The 2011 survey was conducted by the National Center for Transgender Equality.
Transgender parents say that finding their true identity can be lifesaving for them, but at the same time, devastating for their children -- at least for a period of time.
"At first I felt a sense of loss, until a year later, when I saw that my mom was a much happier person," said Sabine. "Now, I am cool with this."
Just last week, New York City's Mel Wymore, a transgender man who is running for city council, discussed the difficulty his two children had during his transition from female to male in 2009.
"We have had very deep conversations and some negotiations around what makes them comfortable," he told the New York Times, adding the children are still allowed to call him, "Mom."
But Dana Beyer, a former surgeon who has run twice for Maryland state delegate, said, "Time heals all wounds if you allow it to."
Beyer hopes to be the nation's first elected transgender politician at the state level.
"I am trying as an advocate to normalize this as another medical condition," said Beyer, 60, who was born intersex [with a small penis and a partial uterus] and raised a boy. "No one knew what that meant then."
She had known since the age of 7 she was a girl, and like others who felt trapped in the wrong body, Beyer said she suffered from depression and even post-traumatic stress.
Beyer transitioned a decade ago when her sons were 14 and 17.
"The younger boy living at home at time no problem and this washed off his back," she said. "My older son was away at school and didn't observe the process and was little more uptight."
At graduation, her older son couldn't introduce his father, now a woman, to his friends.
The brothers wondered if his father's transgenderism meant they were gay. "It's an existential issue," said Beyer. "My father becomes my mother -- what does that mean for me?"
So she matter-of-factly asked them, "OK, guys, do you like boys or girls? … It turns out they were straight guys."
Now both boys are accepting of her new identity, calling her, "Dana."
"Secrecy is the most damaging thing," said Beyer. "You need to let them know you love them and it has nothing to do with them, but you can't hide it. Kids know if you are lying."
Other parents say that taking on a new identity came at a huge cost.
Sarah, not her real name, lost her job, a respectable life in the suburbs and her children when she transitioned from male to female.
"I lost pretty much everything," said the 50-year-old Boston waitress. "I had the American dream. A house with an in-ground pool, I was politically active and president of the Chamber of Commerce."
But the hardest was the loss of her children -- a 27-year-old daughter from a first marriage and a 17-year-old daughter and 16-year-old son from a second marriage.
"I never really understood my sexuality growing up," she said. "I didn't know what gay and transgender were. I thought, 'Oh my god, this is sick.' It was a major taboo in my generation."
Still, Sarah knew something was wrong. "I imagined being female, I was jealous of girls in dresses and I always kept it to myself. I lived in a male world and thought this is what I have to be."
As a man, his world revolved around his children. "I was very close to them. My marriage was on the rocks, but I wanted children -- I loved them so much."
Sarah eventually became depressed and attempted suicide. When the marriage fell apart, Sarah's wife served her with an order of protection and the court revoked her rights as a parent.
Sarah said the children were "scared and devastated" and aligned themselves with their mother.
Now, after facial feminization surgery in 2007 and sex reassignment surgery in 2009, Sarah said she has found inner happiness, but her heart still aches for her children.
"I will always be there for them when they want me," she said. "I just sit here and wait. It's all I can do. Everyone believes it was a very selfish act, maybe so in some way, but it was life or death for me."
For other transgender parents, one child was accepting and another sibling was not.
Hunter Thompson, a 56-year-old divorced acupuncturist from Maryland, raised four children before he transitioned from female to male in 2006.
His oldest daughter, who was 27 at the time, was "fine" with the news. But his 17-year-old daughter "freaked out."
As a girl, Thompson always played with the boys and felt like a boy until puberty. "Everything went haywire for me," he said. By 18, Thompson contemplated suicide.
He married in college and had his first child before graduation. Two sons and another daughter followed.
"The only thing that made it OK to be female was I could produce male children," he said. "I always knew inside that I was male."
First he changed his name then he had hormone therapy. Now, he's had chest surgery and even changed his birth certificate.
"It was fantastic for me -- I started to be who I am," he said. But it was also a difficult time dealing with his children.
"My oldest was fine," said Thompson. "She was old enough to understand that I needed to be who I was."
He held off on telling his son, who was serving in Iraq. But his second daughter worried, "What will I tell my friends, what if I get married?"
She wondered, "What does this make me? Here I am female and my mother is telling me she is male. Does that make me some kind of freak?"
"She is fine now, but there were two years that were rough for her," said Thompson.
His youngest son still lives at home and the family gets together at holidays. The children now agree to call him "Hunter" in public.
"At home they call me Mom, that's fine," he said. "But it's got to be in private."
To other parents in transition, Thompson advises, "Be clear in who you are -- I really think that goes a long way. In the beginning I was terrified … But I was able to stand and say this is right for me and hopefully they will go down this road with me. Just be honest."
As for Sabine, even though she is homeschooled and lives in a liberal "bubble," she has faced the harsh judgment of her peers because of her mother's transgenderism.
"There was one girl I knew who told me if her parents did that, she would disown them," said Sabine. "I thought that was unacceptable."
"Friends can be weird about it," she said. "One friend I used to go to public school with asked me what it was like to have a transgender parent. That was a little strange."
Still most of her friends have been supportive.
Sabine said her sister, now 6, had an easier time because she was so young when her mother became a man.
"She says that there are some special men who weren't born men and some special women who weren't born women, and there are some other people who aren't boys or girls," said Sabine.
She admits transition is hard, but advises other children in the same situation to be patient.
"It usually gets easier after a while and, despite the changes, your parent will always be the same person," said Sabine. "Only, maybe a bit happier."

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