As barriers to family building are decreasing, transgender people are starting families more than ever before. However, their needs are not being met by a healthcare system that still prioritizes heteronormativity. As an HR leader, you have a powerful opportunity to improve access to high-quality care for your transgender employees.
In order to make your benefits inclusive of all people and all pathways to parenthood, you need to understand what kind of fertility support trans parents might need. This guide will help you understand the ins and outs of transgender fertility needs, and how your benefits can best support them.
The building blocks of trans fertility, starting with the three potential steps of transitioning
Gender transition is an incredibly personal process that begins with the exploration of gender identity. When someone feels ready to move forward with actions to affirm their gender, the steps may include social and medical transition. None of the following is required to validate a gender identity, and there is no specific order for these steps.
1. Social—a social transition, changing how one presents themselves
2. Medical—taking hormones or other medications to align the body more closely to gender identity
3. Surgical—undergoing surgical procedures, also meant to align the body more closely to gender identity
The impact of hormone therapy on fertility
There are a lot of unknowns around the long-term impact of hormone therapy on sperm and egg production. There hasn’t yet been extensive research on which hormones contribute to the loss of sperm and egg production or exactly how long it takes to regain fertility after pausing hormones. Here’s what we do know:
- Some people pause hormone therapy to potentially allow for conception. While there is no guarantee fertility will be restored, there have been natural conceptions using this method.
- Many of the changes to a trans person’s physical appearance due to hormone therapy are reversible, meaning that pausing hormones will lead to a reversal. This shift can trigger gender dysphoria. Because of these effects and the impacts on mental health and daily life, many trans people will opt not to pause or stop hormones, choosing to explore other options like surrogacy or adoption.
- While only three percent of trans people preserve their fertility, 51 percent of trans women wish they had.
Options for fertility treatments for trans people
There are surgical transitions that take away access to someone’s own eggs, sperm, or uterus, and some medical transitions can have potentially negative effects on the quality or viability of eggs or sperm. But even if someone has medically or surgically transitioned, they may still be able to have children that are genetically related to them.
The current options to have biological children for trans men (a person who has transitioned from female to male) are:
- Embryo cryopreservation: The procedure removes eggs from the ovaries, fertilizes them to create embryos and lets them grow for several days and freezes them.
- Oocyte cryopreservation: Also called egg banking, egg cryopreservation, and egg freezing, oocyte cryopreservation is a process in which a person’s eggs are extracted from the ovary, frozen, and stored.
- Ovarian tissue cryopreservation: Ovarian tissue cryopreservation can remove the egg-producing portion of the ovary, called the ovarian cortex, before a patient’s treatment, freeze it, and store it. The tissue can be transplanted years later to make pregnancy possible.
The current options to have biological children for trans women (a person who has transitioned from male to female) are:
- Sperm freezing or cryopreservation: Sperm freezing is a procedure that takes place to stabilize sperm in subzero temperatures. If the frozen sperm is mature sperm (ejaculated rather than testicular) it can remain viable for years.
- Surgical sperm extraction: This procedure involves retrieving sperm surgically, often coordinated with a partner’s egg retrieval. The sperm is then frozen and stored.
The importance of transgender fertility support
Your trans employees are likely facing discrimination in medical settings (and beyond):
- Nearly one in five trans people reported being refused care outright because they were transgender or gender non-conforming
- 50% of trans people report a significant lack of provider knowledge or having to teach their medical providers about transgender care
- Three in ten trans people regularly postpone or avoid medical treatment due to discrimination.
Care matching in the fertility journey
Care matching can be an important component of making benefits more important to this community. Care matching, connecting patients with medical providers from similar backgrounds, can support employees as they navigate the healthcare system. The importance of care matching and working with providers who have experience and working with other specialists (like fertility educators and doulas) can help navigate the journey and make care feel easier and more accessible.
Mental health support needs to be inclusive
Mental health support should also include offering benefits with affirming, personalized care oriented toward understanding and appreciating a person’s gender, especially in the family-building journey. In a recent survey of LGBTQIA+ individuals going through fertility journeys, 50% reported feelings of uncertainty and 48% reported feelings of anxiety. The fertility process is emotionally fraught, especially for non-heterosexual couples and individuals. “Gender affirming care helps to lessen the stressors and mental anxiousness within the fertility process,” explains Hawanya Miller, Maven provider, psychotherapist, and co-founder at Dallas Therapy Center. “In a time of great uncertainty and high anxiety, trans people and their partners need care that understands their needs, speaks with them and not at them, and maintains their safety.”
When discussing benefits materials and policies with LGBTQIA+ employees, it’s vital to include mental health support and use language to affirm gender through this time. Be aware of the stress of going through the mainstream medical system as a trans person. “Trans affirming care is still new in the medical field and reproductive care can feel like a battlefield inside and outside the care room,” says Miller. For trans people in the sometimes stressful journey of fertility, offering access to providers who understand and can support their experiences can be a lifeline. Employers can make a huge impact by providing specialized care, care matching, and emotional support for their trans employees in times of need. “Listen, listen, listen,” advises Miller. “Listen to their needs, listen to their silence. Don’t assume you know.”
Designing an LGBTQIA+-friendly ecosystem
Organizations should ensure that the healthcare providers and services they offer to their employees reflect their diverse identities and experiences. A virtual care component can help ensure all employees have access to culturally competent care, regardless of where they live. It’s important for employers to offer support for IVF, adoption, and surrogacy and many trans employees take this route to parenthood, and costs are significant.
- Sperm banking can cost up to $2,500 upfront with fees up to $400 per year
- Egg-freezing can cost upwards of $12,000 with $500 annual fees
- IVF may run up to $14,000 per attempt
Employer financial support can sometimes be the only thing that makes this pathway to parenthood affordable and accessible. These services can also be supported with adoption and surrogacy coaches, like those offered by Maven. By designing an LGBTQIA+ friendly benefits ecosystem, you can reduce stress and improve the health of your employees.
How Maven can support trans people on their fertility journey
When looking for inclusive benefits that support the trans fertility journey, employers should seek out comprehensive, virtual, whole-person care. Maven supports all pathways to parenthood and provides access to culturally-humble care and LGBTQIA+ providers. Maven members are assigned a dedicated Care Advocate, who can affirm and advocate for their needs throughout their fertility journey. Maven also offers surrogacy and adoption services for all members looking to build their families.
Looking to help your team through their fertility journey? Maven is here to help. Maven Clinic offers members 24/7 access to specialty providers through an easy-to-use digital platform that covers everything from fertility to mental health to adoption and surrogacy. Encourage your team to activate their membership today or reach out for more information.
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