Trans and Non-Binary Patients

By Nick Peplow·Founder and editor

Last reviewed 27 September 2026· How this site is researched

Fertility preservation before gender-affirming hormones or surgery is time-critical, and guidelines are clear that the conversation should happen before treatment starts. The best thing you can do is raise it yourself. If you are anywhere near the start of a medical transition and you are not certain how you feel about future children, the thing to do is ask for a fertility referral now and decide afterwards. A referral commits you to nothing.

Why timing matters most

Gender-affirming hormones suppress gamete production. Testosterone usually stops ovulation. Oestrogen with an anti-androgen reduces and often eventually stops sperm production. Whether that reverses if you stop is variable and not predictable in an individual, and after years of treatment it may not reverse at all. Surgery that removes the gonads ends the question entirely.

The window is not the same length for everyone. Sperm banking can start in a single visit and be finished within a week or two. An egg freezing cycle needs roughly two weeks of injections and monitoring. Ovarian tissue freezing needs an operating theatre. If you have heard that preserving fertility means delaying transition by months, ask which option is meant, because for a lot of people it is days rather than months.

Sperm freezing, the quickest option

If you produce sperm, this is the cheapest, fastest and least invasive fertility preservation that exists, so it is well worth asking about. A sample produced at the clinic, a screening blood test, consent forms, and it is in the tank. Costs are a fraction of anything involving a stimulation cycle, usually a few hundred in most countries plus an annual storage fee, though local prices differ and the storage fee is worth budgeting for.

Two practical points. Clinics generally want more than one sample, spaced a few days apart, and not every sample survives thawing equally well, so banking more than the minimum is the sensible version. And a poor sample is still worth freezing. Modern IVF with a single sperm injected into each egg needs very few sperm to work with, so numbers that would once have been dismissed are now usable. Sperm freezing goes through the process in detail.

The barrier here is rarely medical. Producing a sample on demand, in a clinic room, at a point in your life when you may have significant dysphoria about it, can be genuinely hard, and good clinics will recognise that. Some clinics allow collection at home if the sample reaches the laboratory quickly enough. Some can arrange surgical retrieval instead, though that is an operation rather than an afternoon. Ask what the alternatives are rather than assuming the standard route is the only one.

Eggs and ovarian tissue, before testosterone

If you produce eggs, the two options are freezing eggs and freezing ovarian tissue, and they are not interchangeable.

Egg freezing is the established route. It means eight to fourteen days of daily injections to grow follicles, several short scan appointments, and collection under sedation with an ultrasound-guided needle. The drugs raise oestrogen sharply during the cycle, the monitoring involves transvaginal scans, and for many trans and non-binary people each of those can be difficult. It is worth saying so to the clinic, because scans can sometimes be done abdominally and appointments can be scheduled to reduce time in a waiting room built around a different patient group. Start with freezing and preservation for how the options compare, and egg freezing for the cycle itself.

Ovarian tissue freezing is the alternative when there is no fortnight to spare, or when a stimulation cycle is not acceptable. A strip of ovarian cortex is removed surgically, frozen, and can later be grafted back. It needs no hormone injections at all, which is exactly why it gets asked about here. It does involve surgery, it is offered by fewer, more specialised clinics, and its track record is shorter than egg freezing's. See ovarian tissue freezing.

If gonad-removing surgery is planned, there is one thing worth raising with both teams, because it is easy to miss. Tissue can sometimes be preserved at the time of that surgery rather than in a separate operation beforehand. Whether that is offered depends on the surgical team and the local laboratory, and it has to be arranged in advance rather than mentioned on the day.

Stopping hormones to produce a sample

If you are already on hormones, pausing them to recover gamete production is possible. It is worth understanding fully before you decide.

On the sperm side, stopping oestrogen and anti-androgens can allow production to return, often over several months, and sometimes not to the level it was. On the egg side, stopping testosterone usually allows ovulation to return, and a stimulation cycle may then be possible. Neither is guaranteed, and the length of prior treatment appears to matter.

The cost is not mainly financial. It means months without the hormones, a return of physical changes you may have spent years getting away from, and for some people real distress. Some people go through it and are glad they did, and some decide to stop partway, and both can be the right choice. If it is on the table, arrange mental health support in advance rather than improvising it.

Getting the paperwork right

Expect some of the administration not to fit your situation. Consent forms, funding criteria and clinic systems in most countries were written around a couple consisting of a man and a woman, and they carry that shape into every field they ask you to complete.

The practical consequences vary. Funding criteria may define eligibility by a period of trying to conceive that does not describe your situation. Forms may ask for a partner in a role nobody in your life occupies. Records may be filed against a sex marker that decides which tests a system will let a clinician order, which occasionally blocks something as basic as booking the right scan. Where preservation before medical treatment is funded, it is sometimes framed for cancer patients and then read narrowly, so whether gender-affirming treatment counts differs by funder and by year.

None of that is a reason to walk away, and knowing about it in advance means it is simply an administrative task to sort out. Ask the clinic whether it has treated trans and non-binary patients before, and ask the funder for the criteria document rather than a summary. On the storage forms, read the clauses on how long material can be kept, who may use it, what happens if you cannot pay the annual fee, and what happens if you change your mind about who it is for. Those clauses decide what your younger self actually preserved.