Myths About Testosterone and Fertility, Told Through Three Perspectives

Title- Testosterone and Fertility. Images of three faces, labeled, “Me, hoping to be pregnant soon,

I’ve heard so many different things about testosterone and fertility. From the news… and from my doctors. Image of a spiral with me overwhelmed at the center. Around me are faces saying, “You’ll be infertile,

Titled Roman’s Story. The story begins when I was diagnosed with ovarian cancer. I said, “I would like a full hysterectomy. My periods are painful, I don’t want kids, and I’m afraid of cancer returning.

Roman’s Story continued. I was told I was giving up something because of my transness with no consideration for my disinterest in having children. 4 months after starting testosterone I said, “I need a hysterectomy because of endometriosis related pain.

Titled: So what do we actually know about testosterone and fertility? Lots of people who have taken testosterone have become pregnant and birthed babies. There is no evidence testosterone impacts fertility long term. Image of me and Kayden Coleman. I say, “I didn’t have a period for 4 years and got it back a month after stopping testosterone.

Titled: Kayden’s Story. Image of Kayden holding his daughter. He says, “I found out I was pregnant five and a half months in. I’ve been offered more abortions than I’ve been offered information about fertility. There’s a history of trying to keep trans people from having kids.

I am talking with Dr Resetkova. I say, “If the research suggests testosterone just pauses things, why do so many doctors think it makes us infertile?

From WPATH’s Standards of Care, “Many transgender, transsexual, and gender nonconforming people will want to have children. Because… masculinizing hormone therapy limits fertility (Darney, 2008, Zhang, Gu, Wang, Cui, & Bremner, 1999), it is desirable for patients to make decisions concerning fertility before starting hormone therapy.

Title: My Story. Testosterone is a life saving medication for me. But sometimes I avoid my shot. Why? A pie chart that is mostly black and a tiny sliver white. The black part is labelled, “Testosterone fertility anxiety

I am saying, “I wish there were a clear study that showed if long term testosterone use had any impact on fertility. In the mean time, the false assumption that T causes permanent infertility is harming our community.

Titled: Our Community Also Has Solutions. Image of people from the previous page all smiling together. We are healthcare workers, researchers, designers, educators… and we all have wisdom from our experiences. Articles! Data! Stories! Advice! Resources! Expertise! Answers! Support! Community! Check out the Facebook group ‘Birthing and Breast or Chestfeeding Trans People and Allies.’ This is one of many resources!

Titled: Kayden’s Story. Kayden says, “Here’s one example of what I experienced when I was pregnant this year. My doctor had called the clinic to tell them I was coming and that my pronouns are he/him…

Kayden’s story continued. Image of Kayden holding his daughter. He says, “I started testosterone over 10 years ago. I was told there’s a high chance you’re infertile and the chance you’re pregnant is next to none. So I found out I was pregnant five and a half months in. I’ve been offered more abortions than I’ve been offered information about fertility. There’s a history of trying to keep trans people from having kids.

Doctors suggesting unnecessary hysterectomies and telling trans people we’re infertile is one way of stopping trans people from having kids. But also, fourteen U.S. states still require trans people to be sterilized in order to change our gender on our license and/or birth certificate. Map of US with the states WI, MI, WY, NE, MO, KY, NC, GA, AL, AR, LA, OK, AZ, and TX filled in. In TX, individual judges can decide the requirements for gender changes. There may be even more, because some states are unclear about requirements to change gender on identification. In 2017 the European court of Human Rights struck down required sterilization for trans people. Some trans Germans who were sterilized are currently fighting for reparations.

Titled: So, What do we need? Access to information! Understanding how racism and transphobia intersect (and then taking action!) Image of Kayden Coleman saying, “A Black trans man’s experience differs tremendously from that of a white trans man.

Sources: Interviews with Kayden X Coleman, Roman Ruddic, and Nina Resetkova. Conversations with JB Brown and Miles Harris. Thank you. WPATH Standards of Care 2011 “A Mouse Model to Investigate the Impact of Testosterone Therapy on Reproduction in Transgender Men

Correction: The map indicating states that require sterilizing surgeries vary depending on whether an individual is obtaining a gender change on a driver’s license or a birth certificate.

For driver’s licenses, eight states require proof of surgery (but not necessarily sterilizing surgeries), court order, or an amended birth certificate: Texas, Oklahoma, Louisiana, Georgia, South Carolina, Kentucky, Tennessee, South Carolina, and Iowa.

For birth certificates, fourteen states require a sterilizing surgery in order to change the gender marker: Arizona, Montana, North Dakota, Nebraska, Iowa, Wisconsin, Missouri, Arkansas, Louisiana, Alabama, Georgia, North Carolina, Kentucky, and New Hampshire.

You can learn more about identification documents requirements from the Movement Advancement Project.

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Will Betke-Brunswick

Will Betke-Brunswick is a trans and nonbinary cartoonist. They make diary comics, informational comics, and funny comics. Their graphic memoir is coming out in 2022!

Will has written 2 articles for us.

16 Comments

  2. I love your work. This was so accessible and informative!

    Can you do one for trans women and fertility? :) I would be happy to chat about my experience if it’s helpful.

    I had to donate sperm this year, bc I am prepping for bottom surgery. It was weird. Luckily, as of 2021, my insurance (Kaiser) covers it! But I am pretty sure that’s not the norm.

  4. This is awesome, and wow that WPATH citation is ridiculous. Thanks for sharing better info.

  5. Seconding Abeni’s request for the equivalent for trans women, I got someone I’d pass that on to. This was so well done! (A full list of citations in a webcomic? :heart_eyes: My not-so-inner nerd salutes you.)

  7. This is so good! Also way more informative and thorough than the scientific research we read through. We gave up on the idea of reciprocal IVF in part due to a doctor’s outright dismissal of the idea of using my testosterone-taking partner’s eggs. Even though we knew better, it’s exhausting fighting the medical system constantly

  8. This was so informative! It would also be interesting to hear about people’s experiences of going through this single vs partnered.

    Also, can I just say, after having done IVF for 3+ years, and knowing a lot of people who’ve gone through it, I have never heard of anyone getting 14 eggs from a cycle, let alone 18! Geez. Although I have read lots of times that 12-15 is a normal amount.

  9. Thank you!! I’m bookmarking this. In case you haven’t already considered: this would make an incredible zine.

  10. Great resource, it should be put on the wall at health centers/community centers. It really seems like cis doctors are just making assumptions based on how they *feel* about how testosterone should work.

  11. I loved this illustration style. I asked doctors about sterilisation for 15 years now, and it’s only now I’m transitioning that anyone is taking me seriously. It really pisses me off.

  13. FYI – my surgeon referred to my top surgery as “an irreversible FTM gender reassignment surgery” in her letter and I was able to change the sex marker on both my driver’s license and my birth certificate in North Carolina with no problems. It doesn’t solve the problem of requiring *a* surgery, but I figure it’s worth asking your surgeon for similar phrasing if you live in a state listed as requiring sterilization.

  14. I Literally just talked to my provider about how T would affect my fertility like 20 mins ago. Immensely grateful for folks who share their experiences and parse the existing data for the rest of us, and to Autostraddle for giving us the platform and space to do so

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