Rick Zentler wants to have biological children just not in the near future. The transgender man froze his eggs just before undergoing treatment that would soon render him infertile because he knew he needed to plan ahead to make this a reality.
According to NBC news, Zentler, 31, who was assigned female at birth, underwent a hysterectomy and hormone replacement therapy through testosterone soon after with the idea of starting a family on his own terms when the time was right.
“I want four,” he said of having kids. “Because I have 34 eggs on ice, I joke that if I was rich, I could start my own army.”
Talking to NBC news, Zentler, an MBA student at San Jose State University in California, says he plans to hire a female surrogate to carry his children eventually.
Fertility may be the last thing on your mind when you’re experiencing the distress of having a body that doesn’t express your identity. Understandably, many trans and non-binary people are keen to start hormone therapy or have surgery as quickly as possible.
However, you may find it a source of regret if you have treatment without preserving your fertility and then realize later on that you want a biological family. Thinking through all these issues now and understanding your options will help you make an informed decision.
Egg freezing is becoming an increasingly popular option, in 2009, 475 women froze their eggs; in 2016, that number grew to 7,300, according to the Society for Assisted Reproductive Technology, and the trend has extended to trans men as well.
Because testosterone can reduce fertility in trans men over time, and since some may undergo hysterectomies, egg freezing is an appealing option for those who wish to have biological children.
There are challenges, however, unique to trans men. They often find themselves navigating fertility clinics that are unaccustomed to catering to the needs of trans patients. They are also sometimes asked unnecessary and insensitive questions about their gender identity.
Maya Scott-Chung, program director for SprOUT Family, a nonprofit that supports LGBTQ people through the family building process, told NBC News she is not confident that trans people are being properly informed about their reproductive options.
“I still think it’s disturbingly erratic around providers properly educating transgender people about their family building options and around fertility preservation,” Scott-Chung said. Many providers, she noted, are putting trans people “through hormones and/or surgeries” that can “potentially sterilize people without educating them about the impact of it.”
The guidelines from the World Professional Association for Transgender Health, Fenway Health, and the Endocrine Society, among others, advised health providers to make trans patients, both adults, and adolescents, aware of any impact to future fertility that transition-related care may have as part of the informed consent process.
Health care professionals involved in care related to gender transition should discuss reproductive options with transgender patients prior to them taking hormones, according to the guidelines from WPATH.
Vega Darling, 39, a trans-documentary-filmmaker who lives in Atlanta, said he has been on hormone replacement therapy since 2004. He would have liked to have had his own children, he said, but his reproductive glands are no longer viable.
“I really wish that people had just treated me as they would have treated any other person that had come into the office and discussed just reproductive options,” Darling said, “and just realized that both queer and trans people also want to have children.”
Many private health care plans in the United States lack coverage for some, if not all, transition-related care, such as surgery and cross-sex hormones, and may or may not cover fertility treatments.
While a few states have passed legislation requiring insurers to cover fertility preservation for people undergoing cancer treatments, none has been introduced that would specifically require fertility preservation for people preparing to undergo cross-sex hormone treatment or gender confirmation surgery.
“I think the biggest barrier to access to care isn’t just the clinic, it’s the cost, because you’re dealing with a person who a lot of the time is disowned by their family, and they don’t have the finances or let’s say they’re in college,” Eyvazzadeh explained.
Zentler began his transition in his early 20s when he got a mastectomy, which he paid for himself. He held off on taking testosterone injections until he could save enough money to freeze his eggs. He would eventually spend about $9,000 to freeze them, he said, because his ex-husband’s insurance, which he was on at the time, did not cover fertility treatments.
“I’d been holding off on doing the hormone replacement therapy because I didn’t want to miss any of the reproductive systems up,” Zentler said.
For Zentler, who is married to a man, finding a surrogate is the only option. He estimates it will cost him anywhere from $50,000 to $90,000. He currently doesn’t have medical insurance, he added but hopes to have a plan someday that will help pay for surrogacy.
Despite their challenges, all the men said they feel better knowing they have the option of having biological children some day — and are excited to become fathers.
“Oh, that sounds nice,” Zentler sighed. He added: “I’m worried about the cost. So worried.”
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