A Practical Guide to Fertility and Gender-Affirming Hormones in the UK

By: Dr Rhy Brignell

Dr Rhy Brignell BA MA Ph.D

Rhy is the Director of Service Delivery at Eden New Life and is responsible for ensuring that all of our subscribers get fast, high- quality care in accordance with our treatment protocols. They hold a PhD from the University of East Anglia and have specialised in gender services for more than 4 years, managing and advising on service delivery for thousands of patients. This is one of a series of articles where Rhy shares guidance and ideas with our members.

At a Glance

Gender-affirming hormone therapy can significantly impact fertility, with effects varying by treatment type and duration. While some changes may be reversible, long-term outcomes remain uncertain. 

Fertility preservation, such as egg or sperm freezing, is most effective before treatment. Informed decision-making, clinical guidance and early planning are essential to balance transition goals with future reproductive options.

Understanding Fertility and Gender-Affirming Hormonal Treatment

The question of what to do about fertility when we want to pursue gender-affirming hormone treatment can be a very difficult and personal one. 

It can be really hard to think about whether we may or may not want to have children in some nebulous, far-off future, when we overwhelmingly want to start gender-affirming treatment as soon as possible in the present. 

In this guide, I’ll cover what gender affirming hormones are, some potential effects of gender-affirming hormone therapy that can impact fertility, as well as the basics of what fertility preservation for transgender individuals includes and the options available to you.

What are Gender-Affirming Hormones?

Gender affirming hormones are medication used to help an individual align their physical characteristics with their gender identity. 

They work by introducing hormones typical of the gender an individual identifies with. This also reduces the effect of the hormones associated with their sex assigned at birth.

For transfeminine individuals, treatment with these hormones typically involves oestrogen alongside testosterone blockers, which lead to developing breasts, softer skin, and changes in how fat is distributed in the body. 

For transmasculine individuals, it involves using testosterone, which can lead to changes such as a deeper voice and more body hair.

Is Gender-Affirming Hormone Therapy Safe?

Gender affirming hormone therapy can be safe and effective only when it is carefully assessed, prescribed and monitored by experienced clinicians and healthcare professionals from start to finish.

But like any medical treatment, it carries risks as well as benefits. This is why a personalised and informed gender-affirming hormone therapy approach is ideal to minimise the risks and harness the benefits.

At Eden New Life, we begin treatment only after conducting a thorough assessment that includes your medical history, goals, and any factors that may affect the therapy process. Once the treatment begins, we ensure regular monitoring to confirm if your body is responding as expected. This also allows us to identify and address any concerns early.

Will Gender-Affirming Hormones Affect My Fertility?

The long-term effects of gender-affirming hormones on fertility are not clear, as there is a lack of long-term scientific data. However, we do know that taking testosterone impacts fertility as it generally suppresses the ability to produce eggs and changes the uterine environment. 

We also know that taking oestrogen impacts fertility as it generally suppresses the ability to produce sperm and causes testes to shrink. However, we don’t know to what degree this affects everyone, and there are differences in individual outcomes.

Can Fertility Return After Stopping Hormones?

Generally speaking, the longer you have been on hormone treatment, the more likely it is that your fertility will be permanently impacted.  Over time, you may lose your ability to produce viable eggs or sperm entirely.

There is a possibility that stopping hormone treatment after you’ve already started could lead to fertility returning, but there just isn’t enough data out there to reliably advise on this. This is why clinicians want us to really think about our preservation options so that we can make an informed decision before starting gender-affirming treatment.

Do I Still Need to Use Contraception?

Yes, because gender-affirming hormones are not a form of contraception. Even though hormones are likely to affect your fertility, you could still be producing viable eggs or sperm, so it’s important to still use contraception.

It’s also worth noting that if you are taking testosterone and fall pregnant, you must stop taking testosterone as it can adversely affect the development of the foetus. Also read about how gender affirming hormones can potentially affect your sex life.

What Does Fertility Preservation for Transgender Individuals Entail?

If you want children in the future, or just want the option open to you, you may wish to preserve your fertility by having your sperm or eggs frozen and stored until you’re ready to use them. The ideal time to do this is before you’ve started any gender-affirming hormone treatment. 

You can still preserve after you have started hormones, but you’ll likely need to stop your hormones for a while, and there is no guarantee that the hormones won’t have already impacted your fertility. If you are considering stopping, always speak with your health provider (or Eden New Life specialist) beforehand.

Before you undertake any preservation procedures, you will likely be screened for various infectious diseases and genetic conditions with a blood test.

Freezing Eggs

Freezing eggs starts with taking medications to encourage your ovaries to produce more eggs. Once this is complete, the eggs are collected in a minor surgical procedure under sedation. It’s mostly very safe, but there are some risks involved (heads up - this link uses gendered language).

Freezing Sperm

Freezing sperm usually involves masturbating or using vibratory stimulation to collect a sample, which is then frozen and stored. If that’s not something you’re comfortable with, there are other options, like surgical sperm extraction, though these methods are more invasive and involve a minor surgical procedure. 

You can now store eggs and sperm for up to 55 years (it was previously only 10 years for most people), though you’ll have to renew your consent every 10 years for the storage facility to continue storing them lawfully.

Where Can I Go for Preservation?

You may be able to access fertility preservation under the NHS, but this is heavily dependent on where you live and what funding options are available locally to you. 

NHS funding decisions are made independently in England, Scotland, Wales and Northern Ireland, and in England, the decision is broken down further between different local Integrated Care Boards (ICBs). 

Unfortunately, there is also no official guidance on NHS fertility preservation funding for transgender people, which means decisions on who gets access to this kind of care can vary, since there’s no clear direction for doctors or commissioning groups to follow.

Fertility Preservation Options for Transgender Individuals

If you want to pursue preservation under the NHS, your GP is the best person to advise you, as they should have information on funding specific to your area. Fertility Network UK also has lots of useful guidance on its website.

If you can afford it financially, you can also choose to pay privately for preservation, as offered by services such as Care Fertility. The Human Fertilisation and Embryology Authority (HFEA) has a tool on its website that can help you choose a private clinic that’s right for you.

Where Can I Find Out More Information?

The HFEA has a great resource that breaks down key information about fertility preservation for transgender and non-binary people, which I recommend reading.

How Eden New Life Can Support You

We provide a safe, supportive and personalised approach to gender-affirming care. Our main focus is to help you make informed decisions which are in your best interests. 

If you are considering gender-affirming hormone treatment, we will guide you through the complete process, from the initial intake session to ongoing monitoring review sessions every 12 weeks. Managing your treatment and costs becomes easier with our subscription plans.

Before starting any treatment, our specialists will also talk you through the effects of gender affirming hormones on fertility and answer any questions you may have during your initial sessions before you start hormone therapy. 

If you are thinking of starting gender-affirming hormone treatment with us, you can read more about the expected effects on fertility via the Patient Information Sheets on testosterone and oestrogen available in our FAQs.

If you have already started treatment and want advice on your fertility options, our specialists will be able to help in your regular review sessions.

If you have any questions or would like to discuss your options, we are here to help. For confidential, professional guidance on gender-affirming care, contact us today.