Fertility and HRT
Fertility is the one topic on this site where the timing of the decision matters more than the decision itself. Hormones affect fertility in both directions, nobody can promise how much of it comes back if you stop, and the simplest options for storing sperm or eggs are available before you start and much harder afterwards.
Plenty of people are certain they will never want biological children, and that is a perfectly good answer. It should be one you reached, though, not one made for you because nobody raised it. WPATH's Standards of Care recommend that fertility is discussed before hormones start, and most good prescribers raise it.
What follows is the part specific to hormones. The detail of fertility treatment itself, the odds and the costs, belongs with a fertility specialist.
On this page
What feminizing hormones do
Estrogen and the testosterone blockers that often go with it reduce sperm production, often to very low levels or none at all, and usually within months. Anti-androgens and GnRH agonists add to the effect. Erections and ejaculation often change too, which is a separate question from whether any sperm are present.
What happens if hormones are stopped is less certain. Some people recover sperm production after months off hormones, some only partly, and some not at all, and the longer someone has been on hormones the less predictable it tends to be. The studies are small, and nobody can tell you in advance which group you will fall into. Which changes are permanent puts fertility alongside the other changes.
An orchiectomy, removal of the testes, ends sperm production permanently. Hormones and surgery covers what changes with your hormones afterwards.
What testosterone does
Testosterone usually stops periods and ovulation within months, though not always straight away and not for everyone. Periods on testosterone covers the timeline.
The ovaries and eggs are generally thought to stay in place underneath, and there are documented cases of people conceiving or having eggs retrieved after pausing testosterone. How reliably that works, and how long being on testosterone affects it, is not well established, and nobody can promise an outcome.
A hysterectomy with removal of the ovaries ends fertility permanently. A hysterectomy that leaves the ovaries does not end egg production, but it does mean any future pregnancy would need a surrogate.
Testosterone is not contraception
Stopped periods do not mean you cannot get pregnant. Ovulation can still happen on testosterone, and testosterone can harm a developing pregnancy, so if pregnancy is possible from the kind of sex you have, you need contraception as well. Periods on testosterone covers which methods are usually used alongside it.
At your first appointment on testosterone
Ask directly which contraception your prescriber recommends alongside it. If they do not bring it up, that is not a sign you don't need it.
Storing sperm or eggs before you start
The options are the same ones anyone preserving fertility uses.
Sperm banking means giving samples that are frozen and stored. It is relatively quick, often done over a few visits across a couple of weeks, and the least invasive option. Some people find the process itself distressing, and clinics that see trans patients regularly are usually better at handling that.
Egg freezing means a course of hormone injections to stimulate the ovaries, then a short procedure to collect the eggs. It takes a few weeks and involves a temporary rise in estrogen, which some people find hard. Some people freeze embryos instead, if they have a partner or donor.
Both work best before hormones start, and both involve storage fees that continue for years. Public funding for fertility preservation before gender-affirming treatment exists in some places, including parts of the NHS, and is patchy or absent in others.
Before your first prescription
Ask whether your health system or insurer funds fertility preservation before gender-affirming hormones, and how long the wait is. If it is funded but slow, that is worth knowing before you set a start date.
If you are already on hormones
It is not necessarily too late. Some people pause hormones to bank sperm or freeze eggs, and fertility specialists do this regularly. It is a real cost, though. Pausing means some of the changes you started hormones for may slow or partly reverse for a while, and for many people that is a hard few months.
Whether and how long to pause is a decision for you, your prescriber and a fertility specialist together. Do not stop hormones on your own to try this; the specialist will want to plan the timing, and there are ways to make the gap shorter.
What it costs, roughly
Costs vary widely by country, clinic and what's funded, so treat these as very rough, self-pay orders of magnitude rather than quotes:
- Sperm banking is the cheaper option. In the US, collection and freezing commonly run from several hundred to a couple of thousand dollars, depending on how many samples and what testing is included.
- Egg freezing is far more expensive, because of the stimulation drugs, monitoring scans and the collection procedure. In the US a single cycle commonly costs in the low tens of thousands of dollars including medication; UK private clinics are usually somewhat lower but still in the thousands of pounds.
- Storage is charged every year on top, commonly a few hundred dollars or pounds a year, for as long as the samples are kept.
Using what you've stored later, through IUI, IVF or a surrogate, is a separate and often larger cost. Ask any clinic for an itemised quote that includes medication, storage and what happens if a cycle is cancelled.
Having children later
Storing sperm or eggs is one route to biological children later, and not the only one. People on hormones become parents through a partner's pregnancy using stored or fresh sperm, through IVF using stored eggs and a partner or surrogate, through donor eggs or sperm, through adoption and fostering, and through step-parenting. Which routes are open depends on your body, your partner if you have one, the law where you live and money.
Some trans men and non-binary people carry a pregnancy themselves after being on testosterone. That means stopping testosterone first, under a prescriber's and fertility specialist's guidance, waiting for periods and ovulation to return, and staying off it through the pregnancy. It's a significant decision, because the reversible changes drift back for a while, and the specialists who do it regularly can talk through the timing and what to expect.
None of this needs deciding before your first prescription. What does need deciding early is whether to keep the simpler options open, which is why this page sits where it does.
Deciding, and deciding not to
The people I have seen find this easiest were the ones who treated it as a separate question with its own deadline, not a detour on the way to hormones. Some decided quickly that they did not want to preserve anything. Some banked or froze and never used it. Some were glad years later that they had.
If you are unsure, price the options and find out how long they take, then decide whether a few weeks' delay is worth it to you. I also run a separate site, IVF and Fertility Guide, which goes through what egg freezing and sperm banking involve and cost in more detail.
Frequently asked questions
Will HRT make me infertile?
It usually reduces fertility a lot while you are on it, and nobody can promise it fully returns if you stop. See what feminizing hormones do and what testosterone does.
Can I get pregnant on testosterone?
Yes. Stopped periods do not mean no ovulation, and testosterone can harm a pregnancy, so contraception is still needed. See testosterone is not contraception.
Should I freeze eggs or bank sperm before starting hormones?
It is your decision, and it is easier before you start than after. See storing sperm or eggs before you start.
I'm already on hormones. Is it too late?
Not necessarily. Some people pause hormones under a specialist's supervision to preserve fertility. See if you are already on hormones.
Can I carry a pregnancy after being on testosterone?
Some people do, after stopping testosterone under a specialist's guidance and waiting for ovulation to return. It isn't guaranteed. See having children later.