The journey to parenthood for transgender people is particularly fraught with obstacles. In the United States, 19 percent of transgender adults are parents. While there has been an increase in the prevalence of transgender parents, they are often faced with unique, complex, and often unnecessary barriers. Part of the problem lies in a lack of understanding of the differences between sex and gender as well as the distinct healthcare needs of transgender people.

Sex is the biological classification of people based on anatomy, chromosomes, hormones, internal reproductive organs, and genitals, generally classified at birth. The attributes of gender are socially constructed and learned, representing a range of characteristics pertaining to femininity and masculinity. Gender identity exists on a spectrum and is complex; as some individuals identify with a gender different than the one associated with their biological sex and others identity with multiple genders.

Cisgender or cis is defined as identifying with the same gender identity associated with the sex assigned at birth. The terms transgender and trans describe people who do not identify with the gender they were assigned at birth. Although many trans people undergo medical procedures and hormone therapies to affirm the identity they transition to, some transgender individuals do not undergo this process but are nevertheless still transgender. Transgender people, including transgender parents, are not a monolith.

Genetic Barriers to Trans Parenthood      

Compared to cisgender parents, transgender parents face more barriers as they navigate gendered parenting roles, unsupportive healthcare providers, and genetic barriers to conceiving.

Transgender individuals’ journeys towards legal recognition are often intertwined with medical sterilization. In many parts of the world, especially in eastern Europe and Central Asia, trans people are still forced to undergo medical sterilization even after their transition. Countries like Japan have only granted legal recognition to transgender people if they are unmarried, infertile, and childless. In some societies where medical sterilization is not an issue, trans people’s identities are only validated if they have surgeries to align with heteronormative and biological modes of reproduction.

Other barriers to genetic parenthood include high costs associated with cryobanks and in-vitro fertilization (IVF), lack of information provided on biological options to have a child, and lack of legal protections for trans parents.

Many transgender people choose to adopt or foster rather than explore the complicated landscape of genetic parenthood. In Australia, two-thirds of trans adults report that a genetic relationship to a child was not important to them and that they prefer adoption and/or fostering. However, trans adults often face discrimination from adoption and foster care agencies in the form of misgendering, intrusive questions about their gender history, and negative perceptions around their ability to parent. Gender transition has also been used against trans parents to revoke child custody of a biological child after a divorce.

Lack of Support for Transgender Parents

Gender non-conforming people can have alienating healthcare experiences when accessing reproductive care. Parenting and pregnancy terminology tends to exclude gender non-conforming communities. In a study on transmasculine men who transitioned from female to male and underwent pregnancy,  many participants reported negative experiences with providers ranging from incorrect pronoun usage to being denied medical treatment. Within the study, transmasculine men who chose to nurse their children reported feeling gender dysphoria – the feeling of discomfort associated with not having your biological sex match your gender identity.

Transmasculine people are often uninformed of the complex implications of surgical and hormonal treatments on fertility options. Transgender individuals who are post-transition may have to reduce or stop their hormone therapies if they want to conceive. Testosterone therapy, for example, can lead to conditions such as anovulation, when the egg doesn’t release from the ovary during menstruation.  Without trans-centric support, information, and resources from their healthcare providers, trans people may not be aware of these obstacles, leaving them to navigate these impactful  decisions largely on their own.

Social stigmatization uniquely impacts transgender parents within the parenting community as well as within their own families. Research shows that when a trans parent’s gender identity is not affirmed by their loved ones, they are more likely to face higher levels of parenting-related stress, feelings of isolation during their pregnancy, and greater perinatal mental health needs than their cisgender peers.

Community & Family Support for Trans Parents

It is critical to examine how trans parents and their families can be supported, and there are known frameworks that reimagine family norms to include trans parents. The family resilience framework, which focuses on familial strengths and restoring balance to a family, benefits children and parents adjusting to new norms and adversity. If embedded within clinical training, research, and community projects, the framework creates new possibilities for trans families.

In addition, many community organizations recognize the importance of intersectional advocacy as Black trans people experience disproportionately high rates of violence, harassment, and homelessness. Transmasculine Black men exploring fertility options report feeling dismissed in their experiences with healthcare facilities. It is critical to recognize the compounded stress and fear that trans parents of color feel in their day-to-day lives when advocating for gender-inclusive parenting resources.

Legislative Policy Solutions

Policy and advocacy efforts led by and centered on trans parents are needed to address their needs. Medical infrastructure and legislative institutions must protect trans parents with gender-affirming treatment and policies. President Biden’s  Fiscal Year 2022 budget request included the language of “pregnant and birthing people,” marking a shift towards gender-neutral language in government policy. In November 2021, the U.S. Department of Health and Human Services reinstated policies with nondiscrimination protections for trans patients, however with increasing state legislative attacks on trans rights, the Senate has still not passed the Equality Act, a sweeping bill that would prohibit discrimination based on sex, sexual orientation, and gender identity in areas such as education, housing, and employment.

Further, governments must put an end to sterilization and eugenic procedures that restrict the reproductive freedoms of transgender people. In February 2021, President Biden signed a memorandum stressing the need to protect the rights of lesbian, gay, bisexual, transgender, queer, and intersex people around the world.

Trans parents cannot navigate the journey of parenthood alone. They must be supported by community networks and have trustworthy healthcare practitioners at their sides. The right to become a parent must be affirmed and must be accessible to all.

Read more:

• How do we establish LGBTI+ inclusive reproductive healthcare?
• Respectful maternal and paternal care is linked to positive mental health outcomes.
• The majority of LGBTQ+ people around the world are not “out”.