Egg Freezing for Transgender Men: What You Need to Know

This article was medically reviewed by Dr. Samuel Pang

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More than half of transgender men (those who were assigned female at birth and identify as a male) say they want children one day. But those who are considering or have undergone hormone replacement therapy (HRT) or gender affirming surgery may wonder about their future ability to have biological children. In this article, we’ll review how egg freezing works, and if it’s possible for transgender men.

Egg freezing for transgender men

Egg freezing, also known as oocyte cryopreservation, is a process that involves extracting and freezing eggs for potential use in future. Before extracting the eggs from your ovaries, they are matured using hormonal stimulation for about two weeks. This leads to increased estrogen hormone levels, which may be difficult for some transgender men as it can exacerbate gender dysphoria. 

The extracted eggs can then be cryopreserved and stored for many years, and when you’re ready to become a parent, the cryopreserved eggs can be thawed, inseminated with sperm in a laboratory.  This is known as in vitro fertilization (IVF). If the eggs fertilize successfully and develop into embryos, the embryos may potentially be transferred into the uterus attempt to achieve pregnancy. This may be your uterus, the uterus of your partner, or a gestational carrier (surrogate). 

It is important to note that not all cryopreserved eggs will survive the freeze/thaw process and only those which survive can be inseminated with sperm.  Furthermore, not every egg that is inseminated will fertilize successfully and not every egg which fertilizes will develop into an embryo which is suitable for transfer into the uterus.  And not every embryo that is transferred into the uterus will result in a successful pregnancy or live birth of a healthy baby.  In other words, freezing 10 eggs does not mean that you can have 10 babies.  Freezing your eggs provides you with the opportunity to have biological children, but does not guarantee that you will definitely be able to have biological children from the frozen eggs.

When is the best time to freeze my eggs, before or after transitioning?

It is generally recommended to freeze your eggs before you start hormone therapy or undergo any gender-affirming surgeries, as these treatments can affect your egg production and quality.

In fact, the World Professional Association for Transgender Health (WPATH) and Endocrine Society both recommend that all transgender patients be counseled on options for fertility preservation (egg freezing) prior to transition. The American Society of Reproductive Medicine (ASRM) also put out a statement that providers should offer fertility preservation counseling to individuals before gender transition.

Can I freeze my eggs if I’ve started transitioning?

It may still be possible to freeze your eggs after transitioning, but it largely depends on the medical procedures you have had done. We’ll discuss those in more detail below. 

Can I freeze my eggs if I have started hormone therapy?

If you have already started hormone therapy, such as testosterone (T) therapy, it may still be possible to freeze your eggs. However, your doctor will likely recommend discontinuing testosterone before you proceed with the egg freezing process.  

Stopping hormone therapy, even temporarily, is easier said than done. Transgender men who stop testosterone to freeze their eggs have reported both physical and mental difficulties. These challenges can include fatigue, alterations in voice and body odor, and the return of menstruation, potentially leading to feelings of increased femininity and heightened gender dysphoria.  This is one of the reasons why it is preferable to freeze your eggs before you start  testosterone therapy.

While it has traditionally been recommended that transgender men go off testosterone to freeze their eggs, this may be changing. In 2022, UCSF reported that two transgender men were able to have their eggs retrieved without stopping testosterone. The researchers suggested more studies to confirm the findings, because it is unknown what impact the on-going use of testosterone may have had on these eggs, and whether these eggs will ultimately result in viable embryos or healthy children.  We may not have answers to these questions for many years.

How does testosterone (T) therapy impact fertility?

Testosterone (T) therapy affects fertility by leading to an anovulatory state and amenorrhea, meaning you no longer ovulate or have menstrual periods. But this is usually reversible when you stop testosterone (T) therapy. 

While more research is needed, one study from Boston IVF found that transgender men who froze their eggs have just as good outcomes as cisgender patients. More than half of the transgender male patients in the study had been on testosterone (T) therapy before egg freezing, and all of them stopped taking testosterone for an average of four months before starting their treatment cycle.

Another study out of Israel found the same thing: there was no difference in the number of eggs retrieved between transgender men and cisgender women. The authors concluded, “Transgender men have an excellent response to ovulation stimulation even after long-term exposure to testosterone.” 

One study from Boston IVF found that transgender men who froze their eggs have just as good outcomes as cisgender patients.

Can I freeze my eggs if I’ve had gender affirming surgery?

It depends on what was involved in the surgery. If the ovaries were removed (an oophorectomy or total hysterectomy), you will not be able to freeze your eggs. This is because egg freezing requires the ovaries to produce mature eggs, which are then retrieved and frozen for potential use in future. If the ovaries have been removed, then egg freezing is no longer an option.

However, if you have not had your ovaries removed, egg freezing may still be an option.

Can transgender men get pregnant?

Say you freeze your eggs now and are wondering if you can still get pregnant down the line. Transgender men who have a uterus may be able to become pregnant and carry a pregnancy to term. This is because testosterone therapy does not usually have an irreversible impact on the uterus. However, you would need to discontinue testosterone therapy in order to be pregnant, as you cannot take testosterone during pregnancy.  In addition, transgender men would face the same issues as cisgender women in becoming pregnant and carrying a healthy pregnancy, like age and overall health. 

Even if you cannot or do not want to become pregnant, it is still possible to have a genetic tie to your future child by freezing your eggs. Those eggs can potentially be fertilized and cultured into embryos in an IVF laboratory, following which they can then be transferred either to the uterus of a partner or a gestational surrogate to carry the pregnancy. 

What is ovarian tissue cryopreservation?

Ovarian tissue cryopreservation is an experimental technique involving the removal and freezing of a small piece of ovarian tissue from the ovary. The frozen tissue can later be thawed and transplanted back into the body, allowing the ovaries to produce eggs and potentially enabling the patient to conceive a biological child. This strategy has mostly been used to preserve fertility potential in cisgender women who need to undergo treatment for cancer which would negatively impact the eggs in the ovaries.

While ovarian tissue cryopreservation is still considered an experimental technique, it has shown promising results in several studies and has already resulted in at least 60 live births worldwide.

We can help you freeze your eggs

If you’re interested in freezing your eggs, it is important to find a doctor who can provide sensitive and affirming care for your journey. Our Freeze by Co platform makes egg freezing more accessible, and we can help connect you with our partner fertility clinics that have experience working with transgender men. Learn more.

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