The thorny subject of fertility in relation to members of the trans and non binary community is one which often gets media attention. Tales of pregnant men and dads breastfeeding are a particular favourite of the tabloid fixation with trans people, positioning us as curiosities to be put on display. They are also a diversion from the real issue.
There seems to be some sort of suggestion that rejecting ones birth gender yet craving the fulfilment of our basic human need to procreate is somehow at odds: it isn’t.
News that The Equality and Human Rights Commission (EHRC) is threatening the NHS with legal action if it does not urgently update its policies in relation to transgender people is welcome, and highlights the fact that once again, current protocols discriminate against this marginalised group.
The issue of fertility is one that comes up a lot in my practice, when working with younger trans and non-binary people who are faced with the ultimate dilemma: start the right hormones to progress in line with the puberty of the gender with which they associate, thereby alleviating feelings of dysphoria, or put their transition on hold in a bid to give the necessary consideration to whether or not they want to preserve their fertility and future chances of having a baby.
When the feelings of gender dysphoria are so acute that making it through the day can be enough of a challenge, the long-term desire to become a parent can take a back seat, but this does not mean that it is a topic which should be ignored or treated as an added extra. We need to address fertility as part of the journey, one which is discussed in detail and for which there are managed pathways.
Current NHS guidelines operate a postcode lottery style system. Depending on where you live, you can access a pathway for fertility preservation, which is reviewed on a case by case basis. This needs to be consistent across the board. The issue of fertility preservation needs to be clear cut so that people don’t shy away from tackling it head on, after all it is their future.
As it stands, it is often the parents of the younger gender variant people who are left to make the decision on behalf of their child. I couldn’t imagine having to make this choice, when I was younger, or even being a parent watching my child’s mental health deteriorate while this detail is agonised over. It feels like the ultimate trans carrot: your gender or your future – you decide. If you can’t, then maybe you aren’t ‘trans enough’.
The younger people I meet tell me of their agonising wait for hormones. They overcome hurdle after hurdle with the promise of medication at every juncture. Then, just as they reach their goal, the topic of fertility is raised.
The fact is that gender affirming hormones will affect future fertility. For the person suffering with gender dysphoria, future plans for a happy family are the least of their worries. But how is this any different from a child suffering with cancer who has to undergo chemotherapy? In this case fertility is made a priority by those who can see the bigger picture and who can decide on behalf of the patient, just in case their plans for a family change as they mature into adulthood. The same opportunity should be afforded to younger trans and non binary people.
The procedure is relatively straightforward, information on how to retrieve and store eggs and sperm should be front and centre, along with a clear and consistent pathway to managing the procedure.
We need to provide support from the outset so that informed decisions can be made early on in the journey, not at the point when gender affirming hormones are finally introduced.