Fertility Preservation for Transgender and Non-Binary Individuals: What You Need to Know

For many transgender and non-binary individuals, the decision to pursue gender-affirming hormone therapy or surgery is one of the most empowering and deeply personal choices of their lives. But it can also raise an important question: what does this mean for my ability to have biological children someday? 

At The Reproductive Medicine Group in Tampa, we believe every person deserves access to inclusive, affirming fertility care — and that gender-affirming care and future parenthood do not have to be in conflict. Fertility preservation is a proactive step that allows transgender and non-binary individuals to protect their reproductive options before beginning hormone therapy or surgical procedures. 

This guide is designed to help you understand your options, what the process involves, and how RMG can support you every step of the way. 

Why Fertility Preservation Matters for Transgender Patients 

Gender-affirming hormone therapy — testosterone for transgender men and estrogen for transgender women — can significantly impact fertility over time. While some individuals may retain some reproductive capacity even after hormone therapy, the effects are often unpredictable, and waiting may reduce the number or quality of eggs or sperm available for future use. 

Surgical procedures such as orchiectomy (removal of the testes) or oophorectomy (removal of the ovaries) permanently eliminate the possibility of using those reproductive organs in the future. 

Fertility preservation, ideally completed before beginning hormone therapy or surgery, allows individuals to bank eggs or sperm for potential use later — whether they choose to carry a pregnancy themselves, use a partner or gestational carrier, or simply want to keep options open. 

Egg Freezing for Transgender Men and Non-Binary Individuals Assigned Female at Birth 

For transgender men and non-binary individuals who have ovaries, egg freezing (oocyte cryopreservation) is the primary fertility preservation option. The process involves: 

• A short course of hormone stimulation medications to encourage the ovaries to produce multiple eggs 

• Monitoring via ultrasound and bloodwork throughout the stimulation phase 

• A minimally invasive egg retrieval procedure performed under sedation 

• Freezing and storing the retrieved eggs for future use 

It is worth noting that this process does temporarily involve estrogen-based medications, which some transgender men may find emotionally challenging. Our team approaches these conversations with sensitivity and will work with you and your gender-affirming care providers to navigate the process in a way that feels as comfortable as possible.