The desire to have children is universal, no matter if an individual is non-binary, trans or cis-gender. However, family building in the LBGTQ community usually requires more thought and planning.

 

By Dr. Lynn Westphal

The desire to have children is universal, no matter if an individual is non-binary, trans or cis-gender. However, family building in the LBGTQ community usually requires more thought and planning. And gender-affirming therapies can impact future reproduction, so it is important to know about options before starting treatment. 

How the field has expanded

I was one of the first physicians in the US to freeze eggs, starting in 1999. Initially, this was offered under an experimental protocol to cancer patients who were going to receive chemotherapy. Soon after, this became an option for transmen before having their uterus and ovaries removed or before starting testosterone. In the early years, most of the patients were in their 20s and 30s. However, as patients are starting treatment at younger ages, I have been seeing more adolescents who want to freeze their eggs.

Fertility treatment options

There are many ways to have a family, and freezing eggs can give patients more options in the future. Some transmen have had their partner carry the pregnancy. Some have stopped testosterone and carried the pregnancy themselves if they had a uterus. Others have opted to get a gestational carrier. Transwomen who have (frozen) sperm have done insemination/IVF with a female partner or used an egg donor with a gestational carrier.

The need for education

With the increasing use of hormone therapy and gender confirmation surgery, it is becoming even more important to provide education to physicians on healthcare concerns for transgender patients. Hoping to improve counseling and reduce barriers for patients, I have been teaching a class for medical students about fertility options for their LGBTQ patients. It is important that patients get all of the information that they need as early as possible so they can fulfill their reproductive goals. Since I started doing this 20 years ago, it is encouraging to see that more insurers are covering gender-affirming treatment, and more clinics are offering this care.

 

Dr. Lynn Marie Westphal, M.D., FACOG, and Kindbody's Chief Medical Officer graduated summa cum laude from Lawrence University, earned her M.D. degree at Stanford University, and did her residency training in obstetrics and gynecology at UCLA and Stanford University. She did a fellowship in molecular biology at Stanford University and completed her fellowship in Reproductive Endocrinology and Infertility (REI) at UCSF. Dr. Westphal joined the full-time faculty at Stanford University in 1998 and was a Professor in the Department of Gynecology and Obstetrics, Director of the Fertility Preservation Program, Director of the Third Party Reproduction Program, and Director of the REI Fellowship. Her interest in fertility preservation for cancer survivors led her to set up one of the first oocyte cryopreservation programs in the country. She has held numerous national leadership positions and was the President of the Fertility Preservation Special Interest Group of the American Society of Reproductive Medicine from 2008-2009. She was the Director of Women’s Health at Stanford from 2005-2012. In 2012, she co-founded the Stanford Center for Health Research on Women and Sex Differences in Medicine (WSDM) and served as co-director of the program for two years.