A Gender-Affirming Approach to Fertility Care for Transgender and Gender-Diverse Patients

Although many transgender and gender-diverse (TGD) people express a desire to become parents, providing quality counseling that encompasses patients' short-term and long-term fertility options often represents a challenge for health care professionals. Fertility care (from preservation to restoration or assisted reproduction or both) has a low uptake in the TGD population, with barriers including financial cost, concerns regarding health care professionals' biases, and patient misconceptions or lack of awareness of fertility outcomes. Fertility care is particularly important for the TGD population, because gender-affirming hormone therapy can negatively affect fertility. Despite this importance, existing guidelines and research on this subject are limited. This article summarizes the currently available fertility care options for TGD patients and provides our clinical opinion on their best provision. We highlight that it is essential for health care professionals to provide TGD patients with holistic counseling to facilitate informed decision making about their reproductive health before initiating gender-affirming therapy. Fertility counseling should outline the options available for the patient, keeping their needs and preferences at the center of the conversation while advising on the associated risks and financial costs.