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Fertility Preservation

Fertility may not seem like an important issue when you’re transitioning. Understandably, the idea of having children may not seem like a priority. But for some transfeminine individuals, having a biological child becomes very important. Future partners and changes in life circumstances can change people's goals.

We’re committed to helping people who are transfeminine have children if they decide to in the future. Of course, we understand that each transfeminine person will not always choose fertility preservation. But we believe that every transfeminine individual should have the information they need to make the best decision for themselves.

Can Hormone Replacement Therapy (HRT) Make You Sterile?

For some transfeminine individuals who are transitioning, the hormones you take during your transition may make it impossible for you to have biological children.

Procedures like orchiectomies (removing your testicles) can also cause fertility problems.

Researchers don’t know exactly how these hormones can affect sperm in transfeminine people:

  • estrogen
  • progesterone
  • spironolactone
  • flutamide
  • finasteride
  • other anti-androgens

But taking even a short course of these medications may permanently change or stop your body from making sperm. This can make it impossible to have biological children.

Fortunately, University of Utah Health’s transgender health program has a world-class fertility and andrology lab that can help you plan for future children. Our fellowship-trained reproductive urologist, Dr. James Hotaling, has years of experience helping transfeminine individuals preserve their fertility.

Find a Transgender Fertility Specialist

Freezing Your Sperm Before HRT

If you identify as transfeminine, or if you’re in the process of transitioning, you can freeze your sperm so you can use it in the future. You can freeze your sperm any time after you’ve gone through puberty (usually age 12 or 13).

The key here is that you need to freeze your sperm before you start taking hormones. Some patients will have no sperm in their ejaculated semen sample or in their testicular tissue sample just one month after they start taking hormones. 

To freeze your sperm, you can either:

  • make a sperm deposit at our andrology lab, or
  • your doctor can collect sperm from the tissue in your testicle (most likely when you get an orchiechtomy).

The Utah Center for Reproductive Medicine has an andrology lab (sperm lab) that serves transfeminine individuals and has frozen thousands of sperm and testicular tissue samples. Once it’s frozen, the sperm or tissue can last forever on liquid nitrogen. 

Using Sperm from Testicular Tissue

Getting a sperm specimen (a small amount of your sperm) is very simple. But removing sperm from the tissue inside your testicles is more difficult. You will need to have a testicular biopsy in the operating room or during your orchiectomy (a procedure where your testicles are removed in an operating room).

Artificial Insemination vs. IVF

If you’re trying to decide whether you should make a sperm deposit or if you should have sperm removed from your testicles, one important thing to consider is the difference between testicular sperm and ejaculated sperm. 

Testicular sperm—sperm that’s inside your testicles—is removed during a biopsy, or when you’re having an orchiectomy. Sperm from your testicle can make a baby, but it hasn’t learned how to swim yet. If you use sperm from your testicle, you and your partner will need in vitro fertilization (IVF) to help this sperm fertilize an egg and make a baby. 

On the other hand, sperm from your ejaculation can often be used for artificial insemination. During artificial insemination, a doctor will place sperm into your partner’s vagina. Your sperm will then swim to the egg on its own.

Artificial insemination is significantly cheaper and less invasive than IVF. For these reasons, some transfeminine individuals choose to make a sperm deposit instead of having sperm removed from the testicles.

Whatever you choose, it’s important to remove and store your sperm before you start hormone therapy.


Most insurance companies don’t cover sperm freezing or removing sperm from your testicular tissue. Insurance companies consider these types of procedures “fertility” treatments, which typically aren’t covered, even if you have transgender fertility coverage. 

We will work with your insurance company to get whatever coverage is possible. You can learn more about financing options with the Utah Center for Reproductive Medicine.

Schedule an Appointment

Please call the Utah Center for Reproductive Medicine at 801-581-3834 to schedule an appointment to discuss your options.