Transgender Fertility Preservation and Sperm Freezing

4 Important Questions about Transgender Fertility Preservation

For transgender individuals, sperm freezing is likely part of the discussion around preserving fertility. This article will explore fertility challenges among the transgender community and sperm freezing as an effective preservation method.

1. Why Should Transgender Individuals Consider Fertility Preservation?

Desire for Children

People who are transgender are often not educated about the options to preserve their fertility and to have children. About 51% of transgender people indicated that they would have chosen fertility preserving options like sperm preservation if they had been informed about it.

If you are considering hormone therapy, and want biological children, you may want to consider fertility preservation. It’s important that you discuss fertility with your medical professional.

Effects Of Gender-Affirming Therapies

Gender-affirming therapies fall into two main categories:

  • Hormonal treatments
  • Surgical options

Surgical interventions often have irreversible impacts. If the penis and testes are removed, spermatogenesis shuts down. Without sperm, you can’t fertilize an egg.

Hormonal therapies have less permanent implications. Estrogen given to counter male reproductive hormones decreases the production of testosterone. This leads to shrinkage of testes and a drop in sperm production. However, this effect is reversible.

If you discontinue hormonal treatments for at least three months, spermatogenesis restarts. The reversal of sperm count is slower and less prominent, but sperm motility shows rapid improvement.

Experts are still divided on the quality of sperm, though. Spermatogenesis after using hormones is unpredictable and hard to quantify.

2. Is Sperm Quality In Transgender People High Enough For Storage?

A semen analysis test can give you an idea about your sperm health. If you have not started hormone replacement therapy, your sperm parameters will likely be in the normal range.

3. How Can I Freeze My Sperm?

The procedure is simple. The sample is collected through masturbation. This can be done either at a fertility clinic, or at using an at-home option like the Ro Sperm Kit.

If it’s not possible to get a sample from masturbation, testicular tissue may be stored for fertility preservation. Another option is sperm aspiration, in which sperm are collected directly from the testes using a needle.

4. Does Sperm Freezing In Transgender Affect Sperm Quality?

It depends on the semen quality before freezing. Thawing a semen sample that contains sufficient sperm before freezing will give you enough sperm to conceive or to perform assisted reproductive procedures like in-vitro fertilization.


  1. Cheng, Philip J et al. “Fertility concerns of the transgender patient.” Translational andrology and urology vol. 8,3 (2019): 209-218. doi:10.21037/tau.2019.05.09
  2. I de Nie, A Meißner, E H Kostelijk, A T Soufan, I A C Voorn-de Warem, M den Heijer, J Huirne, N M van Mello, Impaired semen quality in trans women: prevalence and determinants, Human Reproduction, Volume 35, Issue 7, July 2020, Pages 1529–1536
  3. P. De Sutter, M.D., Ph.D., K. Kira, M.Sc., A. Verschoor and A. Hotimsky. “The Desire to have Children and the Preservation of Fertility in Transsexual Women: A Survey”,Volume 6, Number 3, 2002
  4. Sterling, Joshua, and Maurice M Garcia. “Fertility preservation options for transgender individuals.” Translational andrology and urology vol. 9,Suppl 2 (2020): S215-S226.