Testosterone HRT & Fertility

For some folks, this may not be a consideration, but for those exploring or interested in family planning visions, read on.

Testosterone HRT impacting fertility and body

Hormone replacement therapy (HRT) is a big, exciting step for anyone who chooses it as a tool to feel at home in their body. For those who take testosterone, there are a wide range of physical effects from facial hair growth to a deepened voice and so on. Another impact is on the reproductive system and fertility.

Testosterone can impact ovulation and menstruation, therefore fertility.

Testosterone affects the way existing hormones, specifically those in charge of menstruation and ovulation, function within bodies in ways that can make someone less fertile. The effect of testosterone on the uterus causes the lining to grow thinner and more stable, which impacts monthly bleeding in that the lining doesn’t shed monthly in the same way it might have prior to testosterone (depending on other hormonal birth control, of course). This is noticeable as less bleeding during monthly bleeding. Over time, bleeding can become less frequent, if it occurs at all. It’s not a guarantee that menstruation completely stops while on testosterone: dosage, frequency, and the length of time on HRT all affect the frequency and amount of bleeding. 

As far as ovulation: testosterone can inhibit some of the other hormonal ups and downs that trigger ovulation, making it less predictable. Many folx ovaries’ will release eggs less frequently, or none at all. However, this does not mean that ovulation entirely stops if someone is taking testosterone.

Pregnancy can happen while on testosterone.

While on testosterone, pregnancy IS still a possibility during the type of sex where sperm from one person enters the vagina/front hole of an ovulating person, and meets their egg. Just because someone with a uterus and ovaries is on testosterone doesn’t mean they are not producing any eggs, even if they are no longer menstruating. (Just as if someone with testes is on Estrogen, it doesn’t mean they aren’t creating sperm.)

Testosterone does not act as a birth control.

If someone wants to continue having sex where sperm enters their body without getting pregnant, they should employ birth control options for themselves and/or their partner(s).

Testosterone and pregnancy coexist in different ways.

While someone on testosterone can get pregnant, if they wish to carry the pregnancy to term they will need to go off of it. testosterone is not safe to a pregnancy and can cause problems to the pregnancy, fetus/baby. In this instance, finding an inclusive birthworker (obstetrician, doula, midwife, etc) may be helpful to ensure sensitivity to gender throughout the pregnancy and birth.

Folx who want to take testosterone and carry a pregnancy in the future can freeze eggs for use later, or go off testosterone and use their existing eggs. If someone on testosterone wishes to use their eggs to create a pregnancy, but does not wish to carry it, they can pursue alternative methods such as in-vitro fertilization (IVF), with or without freezing their eggs, in which a partner or surrogate carries the pregnancy.

Freezing eggs can happen before or after beginning testosterone.

Some folx will choose to store their eggs for a future pregnancy before beginning testosterone both because of the impact of testosterone on fertility, as well as the simple fact that, for all genders, fertility is at its peak at younger ages.

If someone decides to freeze their eggs, the process entails first taking a series of synthetic hormones that stimulate the ovaries to produce multiple eggs (rather than the single egg that typically develops monthly), followed by a small surgical procedure typically under sedation to remove the eggs from the ovaries. 

Egg freezing can certainly be done before beginning testosterone, but if looking to do so after beginning testosterone, it depends on how the body responds to the ovary-stimulating hormones whether or not someone might need to stop taking it temporarily. Prior to this process whether on testosterone or not, it's a good idea to get an ovarian reserve test to determine the quantity and quality of eggs.

Once removed, the eggs that are removed can be stored either as just eggs (to be fertilized with sperm later), or as embryos (fertilized by sperm then stored as an embryo to be implanted later). The eggs or embryos are then stored at a fertility clinic for future use.

Don’t be afraid to reach out to our clinicians with further questions.

There is much left to be desired in the sex education and family planning world for queer, transgender, and nonbinary folx ON HRT. For FOLX members with further questions about testosterone and fertility options, consider scheduling an appointment with a provider. For anyone who isn't a FOLX member, drop us a line at support@folxhealth.com and we'll do our best to help you out.