The Need To Be Trans-Parent: Fertility Conversations A Must For Transgender Individuals

Transgender individuals deserve the choice to pursue all the same paths to parenthood as cisgender people.

One of the reportedly seven newly banned words at the Centers For Disease Control is “transgender.” While the alleged banned list has been denied, the paradox of how we treat issues of transgender individuals cannot be denied. This is particularly true when it comes to the healthcare needs of transgender individuals.

On the positive side, the recent news of Alexandra Chandler, a transgender woman, running for Congress in Massachusetts; the election last month of Danica Roem, the first openly transgender person to be elected to a state legislature; the new delay on acceptance into the military after failed attempts to ban transgender people from serving, and multiple proposed bathroom bans have all resulted in an increased focus on the medical needs and rights of transgender individuals.

Issues related to transgender persons have also received more cultural visibility thanks to Jill Solloway’s award-winning Amazon series, “Transparent,” launched in 2014. Still, the show will shift as the transgender parent character played by Jeffrey Tambor exited the show recently following sexual harassment allegations against him.

Yet even with increased recent visibility on the possibility for uterine transplant in transgender women, transgender individuals’ reproductive needs and desires to be parents are often overlooked.

Unfortunately, as the healthcare system in the U.S. has often failed many transgender people, some countries such as Japan have attempted to limit transgender people’s reproductive rights by requiring they be sterilized prior to legally changing their gender.

As a psychologist in a fertility clinic at Northwestern University, I am keenly aware that transgender individuals who chose to undergo hormonal or surgical interventions may be placing their future fertility at risk. The failure of medical personnel to counsel transgender individuals about these risks prior to treatment could result in future psychological distress should these patients later be unable to have children who are genetically related to them.

Recent research on transgender individuals’ family building plans has shown what may appear to be contradictory results. Transgender youth report low participation in fertility preservation with egg or sperm cryopreservation and low interest in genetic parenting. This is at the same time that transgender adults report a stronger desire for genetic parenting.

How do we explain this difference in desire for genetic parenting?

One hypothesis is that transgender youth are being raised in a more open culture that values all ways of family building than older transgender adults experienced. However, we do not see the same desire for non-genetic parenting in young cancer patients whose fertility is at risk due to chemotherapy.

A changing cultural environment does not appear to be responsible for increased openness to non-genetic parenting through options like adoption.

Another hypothesis is that transgender youth are not planning their reproductive futures as they are focused on medical treatments which can bring their bodies in line with their gender identity. Although this may be true, my work with adolescent and young adult transmen, natal females, who are considering freezing their eggs has unfortunately revealed a darker explanation.

These young men have vividly described to me the fear they held about whether or not they would survive to adulthood to become a parent. Their fears may unfortunately be based in reality.

This year was one of the deadliest years for transgender individuals. Non-fatal violence such as the alleged sexual harassment of two transgender colleagues by Tambor, as well as rape, physical assault and domestic violence are unfortunately common for transgender people.

A 2017 study also found that more than half of transgender individuals have thought about committing suicide and are at a 22 percent greater risk of attempting suicide than cisgender, non-transgender, individuals.

In addition to the fear of violence, my young transgender male patients report that they are also distraught by the fear that even if they survive to adulthood, they may never find someone who will love them and want to build a family with them. These young men are resigned to a future in which if they survive, and if they find love, they will participate in whatever paths to parenthood remain open to them.

Transgender youths’ fears related to survival and finding love indicate that although societal stigma regarding gender identity and diverse family building may be decreasing, it is still shamefully and overwhelmingly present.

Jeff Mateer, President Donald Trump’s 2017 nominee for a Texas federal judgeship, has called transgender youth an example of “Satan’s plan.” Some Republican officials in Virginia have refused to recognize their legislative colleague Roem as a woman.

It is difficult to deny that this stigma is influencing the choices of transgender youth about the diverse ways to build their future families.

Since some transgender individuals and couples may have the ability to conceive without medical treatment, the argument against transgender parenting often focuses on the belief that transgender individuals should not be parents due to concerns about possible negative effects on children from having a transgender parent.

Similar to children of cisgender parents, some children of transgender parents may at times struggle emotionally to cope with their parents’ identity or relationship. This struggle for any child is likely to be influenced by old and diverse hurtful social stigmas against transgender identity; interfaith, interracial, and cross-cultural relationships, same-sex parenting, parents with mental illnesses or other stigmas faced by a child’s parents.

Research in 2017 finds that the stigmatization of family members can be “contagious” and result in the stigmatization of children or in distress of children who accept these stigmas as valid. The normalization of diverse families and people may resolve identity-related distress for children.

There does not appear to be any evidence which proves that having a transgender parent hurts children, rather social stigmas about transgender people hurt everyone. A growing body of research supports that the children of transgender parents are doing well and experience no differences in gender identity than children of cisgender parents.

Transgender individuals deserve the choice to pursue all the same paths to parenthood as cisgender people. Until we eliminate the stigmas about transgender individuals and provide appropriate fertility counseling, that will not be possible.

Dr. Angela Lawson is a clinical psychologist and Associate Clinical Professor in the Departments of Obstetrics and Gynecology & Psychiatry at Northwestern University and is a Public Voices Fellow through The OpEd Project.

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