For most transmasculine individuals, testosterone use suppresses ovulation and can temporarily reduce fertility. However, fertility often returns after discontinuing testosterone, allowing pregnancy or egg retrieval for IVF.
While long-term data is limited, studies suggest that trans men who have taken testosterone can still produce a similar number of eggs as cisgender women during IVF cycles. Egg quality, however, remains less well-studied. Encouragingly, available evidence and clinical experience show that pregnancies and babies after testosterone cessation appear healthy.
It’s important to note that testosterone should not be relied upon as a contraceptive method, as ovulation suppression varies. Moreover, testosterone use during pregnancy is discouraged because it may cross the placental barrier, with unknown effects on the fetus.
Surgical removal of the ovaries eliminates the ability to produce eggs, making pregnancy with one’s own genetic material impossible. Before undergoing oophorectomy, individuals are encouraged to freeze eggs or embryos, and, if possible, store ovarian tissue for future research-based fertility options.
Similarly, a hysterectomy (uterus removal) ends the ability to carry a pregnancy. However, biological parenthood remains possible through IVF—using the person’s eggs and transferring embryos to a partner or gestational carrier.
To pursue pregnancy or fertility preservation, trans men typically need to stop testosterone for several months (usually 3–6) until menstruation and ovulation resume.
This process can be emotionally and physically challenging, sometimes triggering mood changes or gender dysphoria. Accessing supportive care—such as counseling, peer groups, and affirming healthcare providers—is crucial.
The positive news: most physical masculinizing changes, like body hair growth or a deeper voice, are not reversed by temporarily pausing testosterone.
Restarting testosterone after childbirth requires medical guidance. Estrogen plays a key role in tissue healing after delivery, and topical estrogen creams may be prescribed for localized recovery without systemic hormonal effects. Doctors also monitor for blood clot risks when restarting hormones.
If lactation is desired, delaying testosterone resumption is recommended, as the hormone can suppress milk production and may pass into breast milk. Most providers suggest establishing a milk supply before restarting testosterone, though the exact effects on infants remain unclear.
Transmasculine individuals have several routes to biological parenthood:
Unassisted conception (after pausing testosterone)
IUI (Intrauterine Insemination) using partner or donor sperm
IVF (In Vitro Fertilization) with one’s own or donor eggs/sperm
Gestational carrier (surrogacy) if unable or unwilling to carry a pregnancy
Success rates for IUI and IVF generally align with those seen in cisgender populations, largely dependent on age and egg quality.
Many conceive naturally after stopping testosterone. This avoids the cost and invasiveness of medical treatments.
IUI involves placing processed sperm directly into the uterus. It’s a low-cost, low-intervention treatment, though success depends on age and ovulation support.
IVF allows flexibility: eggs, sperm, and the uterus can come from different individuals. Trans men may use their own or previously frozen eggs and can either carry the pregnancy or use a gestational carrier. IVF success rates correlate strongly with the egg provider’s age. Costs typically range from $15,000–$20,000 per cycle.
When using donor eggs or gestational carriers, IVF success rates often improve. However, this also increases costs—egg donors may receive $10,000–$20,000 in compensation, and surrogacy arrangements can add $20,000–$50,000+ in expenses.
Financing fertility care can be challenging, but several supports exist:
Employer coverage: Many companies cover one or more IVF cycles.
Grants and programs: States like New York and California offer subsidized IVF.
Insurance mandates: Some U.S. states require IVF coverage (e.g., MA, NY, NJ, IL).
Loans: Fertility-specific loans with competitive rates are available.
Clinic packages: “Shared-risk” or “multi-cycle” discounts exist but may have hidden costs.
Preserving fertility before starting hormone therapy or undergoing surgery provides peace of mind and keeps options open for biological parenthood later.
The most established preservation method, egg freezing, involves ovarian stimulation with hormones to produce multiple eggs, which are then surgically retrieved and frozen.
While the procedure temporarily raises estrogen levels (which may cause discomfort or dysphoria), it is safe and effective.
Average cost: $15,000+ per cycle, plus $500–$1,000 per year for storage
Success rate: Heavily dependent on age at freezing and lab quality
Tip: Ask your clinic about their oocyte cryosurvival rate (aim for ≥90%).
Alternatively, retrieved eggs can be fertilized immediately and frozen as embryos.
Advantages: Higher survival rates upon thawing; proven long-term reliability.
Considerations: Locks in sperm choice; higher upfront costs (~$3,000+).
An emerging, experimental option—especially for prepubescent trans youth or those unable to undergo egg retrieval. Frozen ovarian tissue may one day be reimplanted or used to grow eggs in the lab, though it remains in early research stages.
Egg freezing is still possible after testosterone use, but it requires stopping hormones for several months. The effects of prior testosterone exposure on egg quality remain unclear.
For those using puberty blockers, fertility preservation becomes more complex. Egg retrieval isn’t possible before ovulation begins, so ovarian tissue freezing may be the only available (though experimental) option.
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To make an appointment with one of our counselors or physicians, please call (212) 661-7673 or email info@surrogacy4all.com. We look forward to hearing from you.
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