Chapter 10 - Parenting in transgender and nonbinary individuals

Abstract

Transgender and nonbinary individuals have a long-standing history of prejudice and discrimination on the basis of gender identity which has led to disparities in health access and outcomes. Over the past decade advocacy efforts have increased legal protections and societal acceptance of gender diversity; however, the transgender and nonbinary community remains an underserved population in medicine. Reproductive medicine highlights this disparity as transgender individuals must overcome significant barriers to access effective counseling and interventions for fertility and pregnancy care. Transgender individuals have the same desire to parent as cisgender people, with motivations, including the intents to nurture and to build families, but face many unique challenges in this pathway to achieve parenthood. Although gender-affirming care has clear life-saving benefits for transgender and nonbinary individuals, such treatment also represents a threat to an individual’s future reproductive potential. As higher numbers of transgender and nonbinary individuals initiate gender-affirming care during their reproductive years, effective fertility preservation counseling and access to fertility preservation services is integral to patient-centered care. Limited literature on the experiences of transgender and nonbinary individuals with fertility and pregnancy services illustrates the diversity of such experiences and impact on gender identity while emphasizing the need for inclusivity and higher standards for gender-affirming care. In delivering fertility and pregnancy care, providers need to avoid making assumptions of sexual orientation based on gender identity, utilize gender-neutral terminology and consistently address patients by their preferred name and pronouns to minimize the potential for gender dysphoria. At the clinic level, inclusive intake forms and educations materials, providing gender neutral bathrooms and developing policies against gender-based discrimination can create an environment that is both welcoming and affirming to transgender and nonbinary patients. Fertility and pregnancy care for transgender individuals is an evolving field with further research into the impact of gender-affirming hormones on fertility, development of treatment guidelines and continued advocacy for increased access and insurance coverage necessary to break down barriers to transgender parenting.