Family planning
Transgender individuals

Overall, transgender and gender diverse individuals face multiple barriers to achieving family planning goals. This community experiences lack of access to reproductive health care settings where they feel accepted, safe, and understood; reproduction help; pregnancy care; and contraception. A barrier that gets in the way of becoming parents is the cost involved with fertility preservation options. For example, the use of sperm cryopreservation in the United States is less than 5% while countries such as the Netherlands, Australia and Israel have higher rates; this may be the result of challenges navigating health insurance coverage. According to a study, in the United States the national median initial bank fee and annual price of storage are $350 and $385 respectively. For those looking for egg preservation, a study calculated that the median total cost (which includes egg freezing, egg thawing, and annual preservation fee) in United States was around $7,444, and the cumulative costs for one live birth of US$11,704 for an individual in the age groups ≤ 35 years. Other common concerns that arise when seeking pregnancy include having to stop or delay of hormonal therapy, worsening of gender dysphoria with treatment related to pregnancy.

Interventions used to facilitate gender transition such as hormone therapy and gender affirming surgeries (e.g., genital surgery, and chest surgery) can temporarily or permanently impact the chance of becoming pregnant. The World Professional Organization for Transgender Health (WPATH) and American Society for Reproductive Medicine (ASRMA) recommend offering counseling on the impact on family planning and transitioning to all transgender individuals Even though many transgender and gender-nonbinary youth express desire to receive fertility counseling and recommendations from professional organization, studies indicate that only a small portion have these conversations with their health care team. Health care professionals attribute lack of knowledge of reproductive health in this community, knowledge limitation due to lack of data on long term effects of hormonal intervention to the inconsistency in discussion around family building

Studies have shown that transgender men can still become pregnant even in the absence of menstruation caused by gendered affirming therapy in the form of testosterone. Inconsistent hormonal therapy such as missed doses, incomplete dosing, or switching therapy regimen, mostly due to barriers noted earlier, may also lead to breakthrough ovulation which can contribute to increase chances of unintended pregnant, highlighting the need of contraception on transgender men (who have conserved reproductive organs) on testosterone if pregnancy is not desired. Furthermore, testosterone can cause abnormal vaginal development in female fetuses (especially in the first trimester of pregnancy), becoming a concern for transgender men who conceived while on hormone therapy. Moreover, condoms are one of the most common contraceptive methods in transgender men, while another subset report no contraception use which can lead to unintended pregnancies. Some challenges to adopting a form of family planning method among this population varies depending on the method. For instance, fear of prevention of masculinization with use of estrogen-based contraceptives, and gender dysphoria with the use of contraceptive devises inside cervical/pelvic cavity. Additionally, negative experiences in the health care system related to gender identity, and denial of health care based on gender identity makes it difficult for this community to access health care and family planning resources.
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