Egg Freezing During Transition

Long-term testosterone therapy suppresses the menstrual cycle and ovulation.

Why before testosterone

Long-term testosterone therapy suppresses the menstrual cycle and ovulation. These usually return after stopping, but recovery varies from person to person. International guidelines (Endocrine Society 2017, WPATH SOC-8 2022, ESHRE 2020) recommend discussing fertility preservation before starting masculinising hormone treatment, taking age, preferences and any gender-related dysphoria surrounding the procedure into account.

Procedure

The ovaries are hormonally stimulated for approximately two weeks with FSH injections. Under ultrasound guidance, multiple mature eggs are retrieved through the vagina under light sedation. The eggs are vitrified (rapidly frozen) and stored in liquid nitrogen.

Considerations

The stimulation phase can cause gender-related discomfort due to temporary breast tenderness, abdominal bloating and elevated oestradiol levels. Some patients choose to postpone starting testosterone or to resume their cycle after an earlier phase. Multidisciplinary consultation with an endocrinologist and fertility specialist is common.

Reimbursement in the Netherlands

Fertility preservation for medical reasons (including gender dysphoria) is covered in the Netherlands under basic health insurance for egg freezing and, in principle, storage; conditions vary by health insurer.

Chances of having a child

Frozen eggs are not a guarantee. The chance of having a child depends on the age at freezing and the number of eggs. Using them later requires IVF, with the embryo transferred to the person themselves, if the uterus is still present, or to a partner or surrogate. This means that a transgender man who wants to use his own eggs and carry a pregnancy himself must temporarily stop taking testosterone.

Young people

For young people who start puberty blockers early in puberty and then continue with testosterone, egg freezing is usually not possible: their ovaries have never matured. Freezing ovarian tissue is still considered experimental for this group. Research shows that few young people make use of the option of fertility preservation, even when it is offered. The question is whether a twelve- or fourteen-year-old can understand what it means not to be able to have biological children later in life; see minors and consent.

Further reading

The broader effects of hormones and surgery on fertility are discussed under fertility and transition. For transgender women, sperm freezing is an option; see sperm cryopreservation. You can read more about how the hormone itself works under testosterone. What you need to know about fertility beforehand is explained step by step on gendermolen.nl.