Why think about this before starting
Many people about to start gender-affirming hormones are at an age when they have not thought about children, or feel sure they do not want them. Family wishes can change over a lifetime, so WPATH Standards of Care Version 8 recommend always discussing fertility effects and preservation options before starting, even when future parenting plans are uncertain.[1]
Knowing the options does not mean you must preserve fertility. It means you can decide with full information.
Why talk early
Discussing fertility before hormones start gives time to consider options without pressure.[1] Preserving sperm or eggs is easiest before hormones, because once they begin the testes or ovaries are suppressed and treatment may need to be paused to collect, which some people find very distressing.
Wishes differ between people
Using gender-affirming hormones is not a measure of mental illness, and care needs vary with goals and access.[4] Some people want biological children, some prefer adoption, and some do not want children at all. Every choice is equally valid.
How hormones affect fertility
Gender-affirming hormones can suppress sperm production or ovulation, and recovery after stopping varies.[1],[2]
- Estrogen and androgen-lowering medicines greatly reduce sperm production; the longer they are used, the more likely it is that production will not fully recover.
- Testosterone usually stops periods and ovulation but does not destroy all eggs. Some people ovulate again after stopping, and pregnancy can occur even during treatment.
- Removal of the testes or ovaries permanently ends the possibility of biological children from one's own reproductive cells.
What is assessed
Your doctor reviews your anatomy, previous hormone use and future goals, then discusses preserving sperm, eggs or embryos, with referral to a fertility specialist if you are interested.[1],[2] People with testes may have a semen analysis before storage to check baseline quality.[3]
Preservation options
Sperm banking is relatively simple: semen is collected and frozen. It is best done before starting estrogen.[1],[3]
Egg freezing requires ovarian stimulation and an egg collection procedure, which takes longer and costs more. Some steps, such as transvaginal ultrasound, may cause gender-related discomfort, so it is worth discussing respectful, sensitive care with the provider.[1],[2]
If you have already started hormones, a fertility consultation is still worthwhile. Some pathways involve a planned pause in hormones.[1],[2]
Every decision, whether to preserve or not, deserves respect, and no one should promise that collection will succeed or that a future pregnancy is certain.[1]
How we care for you at Dr. Kris Clinic
Before hormones start, we talk openly with everyone about fertility, explaining the effects and options without pressure, in English or Thai. If you are interested in preservation, we coordinate referral to a fertility service and plan the timing of your hormones around it.
If you already take hormones and are now thinking about children, we are happy to discuss the options that remain.
Frequently asked questions
I'm not sure I want children. Should I preserve fertility anyway?
That is your decision. Knowing the options early means you do not have to decide in a rush later, and your doctor can explain the pros and cons.
I've already been on hormones. Can I still bank sperm or eggs?
It may be possible, sometimes after a planned pause in hormones. A fertility specialist can advise.
Do I have to preserve fertility before starting hormones?
No. Preservation is an option, not a requirement for starting hormones.
I'm on testosterone and have no periods. Do I still need contraception?
Yes. Pregnancy is still possible; testosterone is not contraception.
Fertility preservation is an option, not a mandatory condition for gender-affirming hormones.[1] Talking about it before you start helps you make an informed decision and plan the timing well.
Talk to a doctor about this
Confidential care in Surat Thani, the mainland gateway to Koh Samui, Koh Phangan and Koh Tao. Tue–Fri 17:00–20:00 · Sat–Sun 10:00–15:00 (UTC+7)
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Dr. Krida Uakridathikarn (Dr. Kris)
Board-certified family physician with certificate training in clinical sexology and sexual medicine. He works at Suratthani Hospital and provides sexual health, hormone and LGBTQ+ inclusive care at Dr. Kris Clinic. Profile and CV
References
- WPATH Standards of Care, Version 8 (2022)
- Endocrine Society: Gender Dysphoria/Gender Incongruence (2017)
- EAU Guidelines 2026: Male Infertility
- WHO: Gender incongruence and transgender health in ICD-11
Keep reading
Main guide: Gender-affirming care
Preparing for Gender-Affirming Hormone Therapy (GAHT)
Testosterone for Trans Men and Transmasculine People
Hormones for Trans Women and Transfeminine People: Safe Regimens and What to ExpectThis article is general education, not personal medical advice or a promise of results. Diagnosis and treatment require assessment by a doctor. Content reflects the cited sources as of the update date.