Skip to main content

Advertisement

SpringerLink
Log in

Reproductive and Obstetrical Care for Transgender Patients

  • Care for the Transgender Patient (C Unger, Section Editor)
  • Published:
Current Obstetrics and Gynecology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The purpose of this article is to briefly summarize some of the available reports regarding fertility, reproduction, and obstetrical care for transgender patients, as well as address some of the ethical and legal considerations.

Recent Findings

Transgender individuals desire reproductive options but reproductive desires among individuals vary significantly. Some options for cross-gender hormones can permanently affect one’s ability to biologically reproduce. Current standard of care is to offer fertility preservation prior to transitioning, but emerging research suggests that there may not be a high uptake in these options. Transgender men seek out culturally competent obstetrical care.

Summary

Reproductive care for the transgender population involves issues such as the effects of cross-sex hormones on fertility, fertility preservation, reproductive options, pregnancy outcomes as well as psychosocial, ethical, and legal considerations. Many of these areas are understudied, leaving exciting opportunities for future research on how to best care for this patient population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Meyer W, Bockting WO, Cohen-Kettenis PT, Harry Benjamin International Gender Dysphoria Association. WPATH standards of care for gender identity disorders-sixth version [Internet]. 2011 [Cited Feb 23, 2017]. Available from:http://www.wpath.org/publications_standards.cfm.

  2. •• De Sutter P. Reproduction and fertility issues for transgender people. In: Principles of transgender medicine and surgery second edition. 2016. p. 331–43. This comprehensive book chapter discussing the fertility of transgender individuals, with discussions of counseling, legal considerations, and fertility preservation options.

  3. Committee on Health Care for Underserved Women. Committee opinion no. 512: healthcare for transgender individuals. Obstet Gynecol. 2011;118(6):1454.

    Article  Google Scholar 

  4. Hembree WC, Cohen-Kettenis P, Delemarre-van de Waal HA, Gooren LJ, Meyer III WJ, Spack NP, Tangpricha V, Montori VM. Endocrine treatment of transsexual persons: an endocrine society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism. 2009;94(9):3132–54.

    Article  CAS  Google Scholar 

  5. Coleman E, Bockting W, Botzer M, Cohen-Kettenis P, DeCuypere G, Feldman J, Fraser L, Green J, Knudson G, Meyer WJ, Monstrey S. Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7. International Journal of Transgenderism. 2012;13(4):165–232.

    Article  Google Scholar 

  6. T’Sjoen G, Van Caenegem E, Wierckx K. Transgenderism and reproduction. Current Opinion in Endocrinology, Diabetes and Obesity. 2013;20(6):575–9.

    Article  Google Scholar 

  7. Murphy TF. The ethics of helping transgender men and women have children. Perspect Biol Med. 2010;53(1):46–60.

    Article  PubMed  Google Scholar 

  8. American Academy of Child & Adolescent Psychiatry. Facts for families: children with lesbian, gay, bisexual and transgender parents [Internet]. 2013 [cited March 5, 2017]. Avaliable from: http://www.aacap.org/App_Themes/AACAP/docs/facts_for_families/92_children_with_lesbian_gay_bisexual_transgender_parents.pdf.

  9. Pfäfflin F, Bockting WO, Coleman E, Ekins R, King D, Gray NN, Pellett E. The desire to have children and the preservation of fertility in transsexual women: a survey. International Journal of Transgenderism. 2002;6(3):97-03.

  10. De Sutter P, Kira K, Verschoor A, Hotimsky A. The desire to have children and the preservation of fertility in transsexual women: a survey. Int J Transgenderism. 2002;6(3):97–3..

  11. Wierckx K, Van Caenegem E, Pennings G, Elaut E, Dedecker D, Van de Peer F, Weyers S, De Sutter P, T’sjoen G. Reproductive wish in transsexual men. Hum Reprod. 2012;27(2):483–7.

    Article  PubMed  Google Scholar 

  12. • Armuand G, Dhejne C, Olofsson JI, Rodriguez-Wallberg KA. Transgender men’s experiences of fertility preservation: a qualitative study. Hum Reprod. 2017;32(2):383–390. doi:10.1093/humrep/dew323. This qualitative study describes why transgender men chose to undergo fertility preservation, what the experience was like for them, and how they coped with situations that sometimes heightened gender dysphoria, suggesting the need for culturally competent fertility preservation options.

  13. Olson J, Forbes C, Belzer M. Management of the transgender adolescent. Archives of pediatrics & adolescent medicine. 2011;165(2):171–6.

    Article  Google Scholar 

  14. Finlayson C, Johnson EK, Chen D, Dabrowski E, Gosiengfiao Y, Campo-Engelstein L, Rosoklija I, Jacobson J, Shnorhavorian M, Pavone ME, Moravek MB. Proceedings of the working group session on fertility preservation for individuals with gender and sex diversity. Transgender Health. 2016;1(1):99–107.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Richards C, Seal L. Trans people's reproductive options and outcomes. Journal of Family Planning and Reproductive Health Care. 2014: jfprhc-2013.

  16. Dumasia K, Kumar A, Kadam L, Balasinor NH. Effect of estrogen receptor-subtype-specific ligands on fertility in adult male rats. J Endocrinol. 2015;225(3):169–80.

    Article  CAS  PubMed  Google Scholar 

  17. Robaire B, Duron J, Hales BF. Effect of estradiol-filled polydimethylsiloxane subdermal implants in adult male rats on the reproductive system, fertility, and progeny outcome. Biol Reprod. 1987;37(2):327–34.

    Article  CAS  PubMed  Google Scholar 

  18. Palmer NO, Bakos HW, Fullston T, Lane M. Impact of obesity on male fertility, sperm function and molecular composition. Spermatogenesis. 2012;2(4):253–63.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Hillier SG, Ross GT. Effects of exogenous testosterone on ovarian weight, follicular morphology and intraovarian progesterone concentration in estrogen-primed hypophysectomized immature female rats. Biol Reprod. 1979;20(2):261–8.

    Article  CAS  PubMed  Google Scholar 

  20. Goerlich VC, Dijkstra C, Groothuis TG. Effects of in vivo testosterone manipulation on ovarian morphology, follicular development, and follicle yolk testosterone in the homing pigeon. J Exp Zool A Ecol Genet Physiol. 2010;313(6):328–38.

    Article  PubMed  Google Scholar 

  21. van der Spuy ZM, Dyer SJ. The pathogenesis of infertility and early pregnancy loss in polycystic ovary syndrome. Best Practice & Research Clinical Obstetrics & Gynaecology. 2004;18(5):755–71.

    Article  Google Scholar 

  22. Fong SV, Louwers YV. Causes of anovulation: normogonadotropic normoestrogenic anovulation non-PCOS. Ovulation induction: evidence based guidelines for daily. Practice. 2016;26:4.

    Google Scholar 

  23. • Wallace SA, Blough KL, Kondapalli LA. Fertility preservation in the transgender patient: expanding oncofertility care beyond cancer. Gynecol Endocrinol. 2014;30(12):868–71. This is one of the first articles we could find directly suggesting that oncofertility preservation research and protocols can be extrapolated and applied to the transgender population.

    Article  PubMed  Google Scholar 

  24. •• Jarin J, Johnson E, Gomez-Lobo V. Fertility preservation in patients with gender dysphoria. In: Pediatric and adolescent oncofertility. 2017. (pp. 179–92). Springer International Publishing. This chapter outlines the effects of cross-gender hormones on fertility as well as fertility preservation options for transgender adolescents.

  25. De Sutter P. Transgender parenthood: gamete preservation and utilization for transgender people. Médecine thérapeutique/Médecine de la reproduction, gynécologie et endocrinologie. 2016;18(2):109–15.

    Google Scholar 

  26. De Sutter P. Gender reassignment and assisted reproduction present and future reproductive options for transsexual people. Hum Reprod. 2001;16(4):612–4.

    Article  CAS  PubMed  Google Scholar 

  27. Fallat ME, Hutter J. Preservation of fertility in pediatric and adolescent patients with cancer. Pediatrics. 2008;121(5):e1461–9.

    Article  PubMed  Google Scholar 

  28. Fauser BC, Nargund G, Andersen AN, Norman R, Tarlatzis B, Boivin J, Ledger W. Mild ovarian stimulation for IVF: 10 years later. Hum Reprod. 2010;25(11):2678–84.

    Article  PubMed  Google Scholar 

  29. Mayo Clinic Staff, Mayo Foundation for Medical Education and Research (MFMER). Egg freezing: what you can expect [Internet]. 1998–2017 [cited February 14, 2017]. Avaliable from: http://www.mayoclinic.org/tests-procedures/egg-freezing/details/what-you-can-expect/rec-20169006.

  30. Yuzpe AA, Brown SE, Casper RF, Nisker J, Graves G, Shatford L. Transvaginal, ultrasound-guided oocyte retrieval for in vitro fertilization. The Journal of reproductive medicine. 1989;34(12):937–42.

    CAS  PubMed  Google Scholar 

  31. Gunnala V, Schattman G. Oocyte vitrification for elective fertility preservation: the past, present, and future. Curr Opin Obstet Gynecol. 2017;29(1):59–63.

    Article  PubMed  Google Scholar 

  32. Domingo J, Cobo A, Pellicer A. Oocyte Cryopreservation. In: Gonadal tissue cryopreservation in fertility preservation. 2016. (p. 1–19).

  33. Centers for Disease Control and Prevention. American Society for Reproductive Medicine, Society for Assisted Reproductive Technology. 2009 assisted reproductive technology success rates: national summary and fertility clinic reports. Atlanta: Centers for Disease Control and Prevention. [Internet]. 2011. [Cited Feb 23, 2017]. Available from: https://www.cdc.gov/art/pdf/archived/art_2009_full.pdf.

  34. Oktay K, Cil AP, Bang H. Efficiency of oocyte cryopreservation: a meta-analysis. Fertil Steril. 2006;86(1):70–80.

    Article  PubMed  Google Scholar 

  35. • Nahata L, Tishelman AC, Caltabellotta NM, Quinn GP. Low fertility preservation utilization among transgender youth. J Adolescent Health. [Internet]. 2017 [Cited Feb 23, 2017]. Available from: http://ac.elscdn.com/S1054139X16309582/1-s2.0-S1054139X16309582-main.pdf?_tid=f7fc7d60-2a33-11e7-bd8d.00000aacb35f&acdnat=1493179015_6caf603c56a074e4135f5b5712590bcb. This is recent study suggests a low uptake of fertility preservation in transgender youth, suggesting the need for more research on transgender adolescents attitudes towards fertility preservation and what the long term effects of their decisions are.

  36. Evans MI, Mukherjee AB, Schulman JD. Human in vitro fertilization. Obstetrical & gynecological survey. 1980;35(2):71–81.

    Article  CAS  Google Scholar 

  37. Balaban B, Urman B, Ata B, Isiklar A, Larman MG, Hamilton R, Gardner DK. A randomized controlled study of human day 3 embryo cryopreservation by slow freezing or vitrification: vitrification is associated with higher survival, metabolism and blastocyst formation. Hum Reprod. 2008;23(9):1976–82.

    Article  CAS  PubMed  Google Scholar 

  38. De Sutter P. Reproductive options for transpeople: recommendations for revision of the WPATH’s standards of care. International Journal of Transgenderism. 2009;11(3):183–5.

    Article  Google Scholar 

  39. •• Obedin-Maliver J, Makadon HJ. Transgender men and pregnancy. Obstetric medicine. 2016;9(1):4–8. This review provides information for providers to create culturally competent clinical environments for transgender men contemplating becoming or currently pregnant.

    Article  PubMed  Google Scholar 

  40. Anderson RA, Mitchell RT, Kelsey TW, Spears N, Telfer EE, Wallace WH. Cancer treatment and gonadal function: experimental and established strategies for fertility preservation in children and young adults. The lancet Diabetes & endocrinology. 2015;3(7):556–67.

    Article  CAS  Google Scholar 

  41. Salama M, Isachenko V, Isachenko E, Rahimi G, Mallmann P. Updates in preserving reproductive potential of prepubertal girls with cancer: systematic review. Crit Rev Oncol Hematol. 2016;103:10–21.

    Article  PubMed  Google Scholar 

  42. Beatie T. Labor of love. Advocate. 2008;26:26.

    Google Scholar 

  43. •• 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. This is the first large review article published on transgender men’s experiences with pregnancy and the postpartum period.

    Article  CAS  PubMed  Google Scholar 

  44. Brener N. Israeli man gives birth [Internet]. 2011 [ cited February 23, 2017]. Avaliable from: http://www.ynetnews.com/articles/0,7340,L-4169089,00.html.

  45. Batacchi ZO, Anawalt BD. Pregnancy in a transgender man with a history of thyroid cancer. In: Late-breaking reproductive endocrinology (pp. LBT-018). Endocrine Society. [Internet]. 2015 [Cited Feb 23, 2017]. Available from: http://press.endocrine.org/doi/abs/10.1210/endo-meetings.2015.RE.8.LBT-018.

  46. Trans Birth [Internet]. 2017 [cited February 23, 2017]. Available from: http://www.transbirth.com.

  47. Berger AP, Potter EM, Shutters CM, Imborek KL. Pregnant transmen and barriers to high quality healthcare. Proceedings in Obstetrics and Gynecology. 2015;5(2):1–2.

    Google Scholar 

  48. Lefkowitz A, Edwards M, Balayla J. The Montreal criteria for the ethical feasibility of uterine transplantation. Transpl Int. 2012;25(4):439–47.

    Article  PubMed  Google Scholar 

  49. Grant JM, Mottet LA, Tanis J, Harrison J, Herman JL, Keisling M. Injustice at every turn: a report of the national transgender discrimination survey. 2011. Washington, DC: National Center for Transgender Equality and National Gay and Lesbian Task Force. [Internet]. 2016. [Cited Feb 23, 2017]. Available from: http://www.thetaskforce.org/static_html/downloads/reports/reports/ntds_full.pdf.

  50. Ellis SA, Wojnar DM, Pettinato M. Conception, pregnancy, and birth experiences of male and gender variant gestational parents: it’s how we could have a family. Journal of Midwifery & Women’s Health. 2015;60(1):62–9.

    Article  Google Scholar 

  51. Childs D. Pregnant man may stop at 3 kids [Internet]. ABC News. 2017 [cited February 25, 2017]. Available from: http://abcnews.go.com/blogs/health/2011/10/31/pregnant-man-thomas-beatie-may-stop-at-3-kids/.

  52. Stark A, Riley L. American Academy of Pediatrics and American College of Obstetricians and Gynecologists Guidelines For Perinatal Care, 7Th Edition. [Internet] 2012. [Cited Feb 23, 2017]. Available from:http://simponline.it/wp-content/uploads/2014/11/GuidelinesforPerinatalCare.pdf.

  53. Centers for Disease Control. Recommendations for the use of folic acid to reduce the number of cases of spina bifida and other neural tube defects. MMWR 1992;41 Available at: https://www.cdc.gov/mmwr/preview/mmwrhtml/00019479.htm; 1992.

  54. Hakim C, Padmanabhan V, Vyas AK. Gestational hyperandrogenism in developmental programming. Endocrinology. 2016 Dec 14:en-2016.

  55. Mueller A, Haeberle L, Zollver H, Claassen T, Kronawitter D, Oppelt PG, Cupisti S, Beckmann MW, Dittrich R. Effects of intramuscular testosterone undecanoate on body composition and bone mineral density in female-to-male transsexuals. J Sex Med. 2010;7(9):3190–8.

    Article  CAS  PubMed  Google Scholar 

  56. Voegtline K, Costigan K, Kivlighan K, Henderson J, DiPietro J. Sex-specific associations of maternal prenatal testosterone levels with birth weight and weight gain in infancy. J Dev Orig Health Dis. 2013;4(04):280–4.

    Article  CAS  PubMed  Google Scholar 

  57. Carlsen S, Jacobsen G, Romundstad P. Maternal testosterone levels during pregnancy are associated with offspring size at birth. Eur J Endocrinol. 2006;155(2):365–70.

    Article  CAS  PubMed  Google Scholar 

  58. • De Wert G, Dondorp W, Shenfield F, Barri P, Devroey P, Diedrich K, Tarlatzis B, Provoost V, Pennings G. ESHRE task force on ethics and law 23: medically assisted reproduction in singles, lesbian and gay couples, and transsexual people. Hum Reprod. 2014;29(9):1859–65. A comprehensive breakdown of the ethical arguments surrounding transgender fertility and reproduction.

    Article  CAS  PubMed  Google Scholar 

  59. Wolfe-Roubatis E, Spatz DL. Transgender men and lactation. MCN Am J Matern Child Nurs. 2015;40(1):32–8.

    Article  PubMed  Google Scholar 

  60. Gorton R, Buth J, Spade D. Medical therapy and health maintenance for transgender men: a guide for health care providers. San Francisco: Lyon-Martin Women’s Health Services; 2005.

    Google Scholar 

  61. National Institutes of Health. LACTMED: Testosterone. [Internet] 2017. [Cited Feb 25 2017]. Available from: https://toxnet.nlm.nih.gov/cgi-bin/sis/search2/f?./temp/%7ExoGDen:1.

  62. MacDonald, T. Tips for transgender breastfeeders and their lactation educators. [Internet] 2017. [Cited Feb 25, 2017]. Available from: www.Milkjunkies.net

  63. Murphy TF. The ethics of helping transgender men and women have children. Perspect Biol Med. 2010;53(1):46–60.

    Article  PubMed  Google Scholar 

  64. Kantsa V, Papadopoulou L, Zanini G. Anthropological and legal challenges of assisted reproduction technologies [Internet]. 2015. [cited March 2, 2017]. Avaliable from: http://s3.amazonaws.com/academia.edu.documents/40958895/Carastathis_Compulsory_Sterilisation.pdf?AWSAccessKeyId=AKIAIWOWYYGZ2Y53UL3A&Expires=1488520526&Signature=v4oBOGqqAwuidVRchGZjU6tkVuY%3D&response-content-disposition=inline%3B%20filename%3DCompulsory_Sterilisation_of_Transgender.pdf.

  65. Currah P. Sterile futures: naturalized reproduction and the pregnant man [Internet]. 2011. [cited March 2, 2017]. Avaliable from: http://scholarworks.umass.edu/berksconference/Workshops/180/6/.

  66. McCandless J. Transgender parenting and the law: we must be creative with legislation to cater for parents who do not fit neatly with the traditional family model. British Politics and Policy a LSE. [Internet] 2017. [Cited Feb 25, 2017]. Available from:http://blogs.lse.ac.uk/politicsandpolicy/parenthood-laws-family.

  67. Murphy TF. The ethics of fertility preservation in transgender body modifications. Journal of bioethical inquiry. 2012;9(3):311–6.

    Article  PubMed  Google Scholar 

  68. Vade D. Expanding gender and expanding the law: toward a social and legal conceptualization of gender that is more inclusive of transgender people. Mich J Gender & L. 2004;11:253.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Washington Hospital Center Department of Obstetrics and Gynecology, Washington, DC, USA

    Alexis D Light, Shawn E Zimbrunes & Veronica Gomez-Lobo

  2. Director of Pediatric and Adolescent Gynecology, Children’s National Health Systems/MedStar Washington Hospital Center, Washington, DC, USA

    Veronica Gomez-Lobo

Authors
  1. Alexis D Light
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shawn E Zimbrunes
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Veronica Gomez-Lobo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alexis D Light.

Ethics declarations

Conflict of Interest

Alexis Light, Shawn Zimbrunes, and Veronica Gomez-Lobo declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Care for the Transgender Patient

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Light, A.D., Zimbrunes, S.E. & Gomez-Lobo, V. Reproductive and Obstetrical Care for Transgender Patients. Curr Obstet Gynecol Rep 6, 149–155 (2017). https://doi.org/10.1007/s13669-017-0212-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13669-017-0212-4

Keywords

Search

Navigation