Trans women & fertility
January 15, 2017 5:07 AM   Subscribe

Does anyone have any non-anecdotal information on how long a woman has to be on HRT for, before it becomes vanishingly unlikely that she can get someone pregnant?

I'm an AFAB nonbinary person, my partner is a trans woman. I understand that until she has an orchiectomy, there will always be a chance that she can get me pregnant.

However, neither of us has anything other than anecdata to refer to as to how long a woman has to be on blockers and/or on estrogen for before it becomes very unlikely that she can get me pregnant.

Does anyone have any reliable data, or has received any credible medical information, on around when this usually happens? We've both asked our doctors and gotten pretty much ¯\_(ツ)_/¯
posted by anonymous to Health & Fitness (9 answers total) 5 users marked this as a favorite
The GLMA (queer doctors association) has a site listing resources on transgender health. Even if you can't find a good answer to your question you might have some luck finding a healthcare provider who's better informed.
posted by forkisbetter at 6:35 AM on January 15, 2017

I just looked around a bit on pubmed and I'm not finding formal studies about this beyond individual case studies from 20+ years ago--most articles about fertility in trans women just suggest freezing sperm beforehand rather than examining continued fertility while on HRT. Having your doctors do a sperm count/analysis would seem to be a good way to get relevant data.
posted by needs more cowbell at 7:08 AM on January 15, 2017

(I realize your intent is probably to *avoid* pregnancy, but most relevant research seems to be from the perspective of trying to preserve fertility; there doesn't seem to be research motivated by the question "when can trans women stop using birth control with their fertile partners.")
posted by needs more cowbell at 7:16 AM on January 15, 2017

Even if you can't find a good answer to your question you might have some luck finding a healthcare provider who's better informed.

This is a question where the best-informed providers in the world will go "No one really knows, use contraception if you want to be sure." It's not simply a matter of the OP and their partner having uninformed providers.

Your only real option is the sperm count suggestion or determining that you are unable to conceive. (But unless your partner is not producing any sperm whatsoever, you kind of end up back at "how sure do you want to be".)
posted by hoyland at 7:20 AM on January 15, 2017 [5 favorites]

Oh, I should add that part of the reason for the "no one really knows" thing is that it seems to vary quite a bit, so roomthreeseventeen's approach of looking at people trying to conceive is probably a good way to go, but I think it'll be hard to find a length of time that gives a sufficient level of confidence.
posted by hoyland at 7:28 AM on January 15, 2017

tl;dr: the most recent lit seems to support "hormones reduce likelihood of pregnancy but the time/amount to make pregnancy virtually impossible are still unproven". From a study published in January 2016:

"Gender-affirming hormones produce impairments in gonadal histology that can cause infertility. Estrogen use by transgender women results in impaired spermatogenesis and an absence of Leydig cells in the testis.8,9 Testosterone use by transgender men causes ovarian stromal hyperplasia10,11 and follicular atresia.10 Gonadal effects of gender-affirming hormones are thought to be at least partially reversible. For example, pregnancy has been reported in transgender men who have previously used testosterone.12,13 Thresholds have not been established for the amount and duration of exogenous testosterone or estrogen exposure necessary to have a permanent negative effect on fertility."

Johnson Emilie K. and Finlayson Courtney. Preservation of Fertility Potential for Gender and Sex Diverse Individuals. Transgender Health. January 2016, 1(1): 41-44. doi:10.1089/trgh.2015.0010.

If you want to dig deeper, citations 8 and 9 go into more depth and are actually relatively old studies:

8. C Schulze. Response of the human testis to long-term estrogen treatment: morphology of Sertoli cells, Leydig cells and spermatogonial stem cells. Cell Tissue Res. 1988;251:31–43.
9. H Lubbert, I Leo-Rossberg, J Hammerstein. Effects of ethinyl estradiol on semen quality and various hormonal parameters in a eugonadal male. Fertil Steril. 1992;58:603–608.
posted by elephantsvanish at 11:25 AM on January 15, 2017 [2 favorites]

Also here's a good guide to sexual health for trans women your partner may find helpful -- it has a bunch of ideas for types of protection for particular types of sex that might be helpful :)
posted by elephantsvanish at 11:35 AM on January 15, 2017

This falls under internet anecdata, but here's an example of a trans man who became pregnant, even though his wife had been on hrt for a decade. The forum may have other examples.
"It's really hard to say how long the window is open. Medical literature used to say six months until permanent sterility, but that's turning out to be incorrect. I ended up pregnant because my wife and I were assuming that it couldn't happen - she was nearly a decade on hormones and blockers, and I was about six months into testosterone treatments. "

A non-hormonal iud (or local hormone iud) may be something to consider to lower the low odds. See this page.
posted by neda at 1:42 PM on January 15, 2017

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