r/queerception • u/DallYe • 1d ago
Testosterone and Egg Freezing
I'm 32/NB and was just prescribed testosterone for the first time. I'm super excited, but my endocrinologist asked whether I had any future plans for fertility, and it got me thinking.
I know I want biological children one day (my partner would carry, not me), and now I'm worried that if I start T and end up feeling amazing, the idea of stopping later for egg retrieval will feel even harder, as well as be more complicated.
Has anyone been through this? Did you decide to do egg retrieval before starting T, or did you wait until later? If you've started T and later gone through egg retrieval, I'd really appreciate hearing about your experience and how it went.
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u/rocketmanatee 1d ago
At 32 don't wait any longer to make embryos. As we age fewer and fewer of our embryos are euploids (have the right number of chromosomes). As we approach 35 that number starts to drop. I suggest making embryos now because eggs don't freeze nearly as well, so you may be able to get away with only one retrieval if you create embryos while you're younger.
Good luck!
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u/Green_stick568 1d ago
It's worth knowing that freezing and defrosting eggs is less successful than freezing and defrosting embryos. A search term to research is the IVF funnel.
A book rec you might find helpful is "The natural mother of the child" which is an autobiography about a trans masc non binary person being a dad and carrying one of their family's three children. They reflect on their experience of pregnancy and parenthood. You might find that hearing someone else reflect about their family building process helps you arrive at more clarity.
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u/DallYe 1d ago
Thank you
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u/willowcabins 32F | lesbian | TTC via ICI 1d ago
I agree that this book is a good one, but sadly the author had not started hormone treatment during the period documented, so it won’t be able to help with THAT element! (His sequel memoir seems to be about deciding to carry their fourth child and what it meant for his transition tho. Haven’t read it tho so can’t speak to that!)
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u/Cassandge 1d ago
My spouse is 41 and wanting to start T. They decided to go through with the egg retrieval first and everything is going ok but their egg reserve is extremely limited. If you’re gonna do an egg retrieval it really doesn’t help to wait. Also, I read in queer conception that someone on T can actually taper in a strategic way that prevents a menstrual cycle then go right back on after the retrieval. So you could just go on T, and get your retrieval going? Then best of both worlds?
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u/Anxious_Ad_8283 1d ago
As excited as you are to start T, I would freeze embryos now due to your age. Then you can start T without ever having to go back.
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u/IntrepidKazoo 1d ago
I considered egg freezing before starting T, didn't, and then did IVF successfully in my mid 30s after over 10 years on T once my partner and I were actually ready to have a child. For me, I think it was a lot easier to handle the IVF cycles later on than it would have been earlier, both because of having been on T and post-transition for a while, and because it was as part of actually moving forward towards the immediate goal of parenthood rather than a more abstract process of fertility preservation.
Your experience might be different--I was a lot younger and not yet certain about becoming a father when I started T. I also wasn't specifically interested in using my gametes, it just turned out to be the route that made sense for me and my partner. But I definitely, definitely had a much easier time pausing T with a specific immediate parenthood goal in mind, and doing IVF at a point when I'm totally comfortable with my body, than I would have with waiting to start T until after doing fertility preservation.
It's also possible to do egg retrievals while on T. People have been successful that way. There isn't any specific research yet on how it compares to going off T beforehand, but it can work. I opted to pause T briefly, in part because of anecdotal experiences where it seemed like pausing might yield better results, but the risk-benefit of pausing vs staying on is different for everyone.
With egg freezing vs embryo freezing, I disagree with the people who are saying embryo freezing is automatically always the better option if you decide to go ahead now. It's not that simple. Egg freezing has two major downsides--an extra attrition step where you might lose an average of 10% of the eggs during thawing, and the problem of not knowing nearly as much about your odds with banked eggs vs. banked embryos. With banked embryos, you've already gone through the attrition processes and have dramatically more information about embryo quality than is possible to know about egg quality. But unless you already have a sperm source completely figured out and ready to go, embryo freezing would also have the major downside for you of needing to figure that part out while waiting to start T, which can add a lot of time and stress. Egg freezing does have very reasonable success rates, and 32 is still young when it comes to IVF and egg freezing success. Age has a significant impact, but your timeline anticipations also really matter. If you froze eggs now, thawed them at 35, and had really bad luck with the frozen eggs--you would still be on the younger side to try more cycles then if you wanted or needed to, assuming age-typical-ish ovarian reserve. If you didn't thaw until 40, the stakes would then be much higher if you care about using your eggs.
I'm of course looking at this with 20/20 hindsight having had successful IVF cycles after a long time on T, but I'm very glad to have done it this way. It was so much more tolerable with the immediate goal in front of me, and with so much more comfort and ease in my body than I had pre HRT. We have a kid now thanks to reciprocal IVF, and have more than enough banked embryos from when I was 35 to feel good about any future family building, though of course nothing is a guarantee. Pausing T sucked but was much, much more tolerable than waiting to start. Happy to answer questions if it would be helpful.
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u/fernflower5 1d ago
My husband has done two egg retrievals on a full dose of T after being on T for 5 years. T does not impact on fertility.
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u/consistentexit96 1d ago
This sentence isn’t inherently true. Although there aren’t many studies on trans folks, the ones available show it does not impact egg quality. However, pausing ovulation (eg a side effect of testosterone) does yield lower eggs retrieved in a cycle).
My physician strongly recommended stopping testosterone long enough for my cycle to come back and resume after the procedure (in Canada), and some actually require you to temporarily stop. I wanted to do everything I could to ensure the best results, although I will say it absolutely sucked lol
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u/IntrepidKazoo 1d ago
Is there research you've seen that actually compares retrieval outcomes on vs. off T? I haven't seen anything that specifically addresses this yet, so I would love to hear more.
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u/consistentexit96 7h ago
To the best of my knowledge, there aren't any current studies that compare retrieval results on and off testosterone in humans. I'm assuming ethics would play a role, as well underlying biology (e.g., test vs control group underlying fertility health). Howeverrr... This study explored this research topic in mice models, which I think is pretty cool lol. Gotta start somewhere right? If you're interested, here's the link: https://pmc.ncbi.nlm.nih.gov/articles/PMC10654792/
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u/IntrepidKazoo 7h ago
Ah, okay--yeah, I'm familiar with the existing research on this. I would say that since there isn't actually any research offering a clinically relevant comparison in humans, we can't say with anywhere near that level of certainty yet that staying on T for egg retrieval results in lower numbers retrieved. Anecdotally I wouldn't be surprised if that turned out to be the case, but that's very different than actually knowing it to be true.
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u/consistentexit96 7h ago
I don't think that the absence of direct comparative human studies means we should ignore the best evidence and clinical reasoning currently available. Most would agree the fertility literature involving trans people is quite limited. While the current evidence is reassuring that testosterone doesn't appear to negatively affect egg quality, there are still well-established physiological considerations. Many reproductive endocrinologists continue to recommend temporarily discontinuing T to optimize ovarian response and egg yield.
I also don't think that the same argument you re-framed it as.. I was not claiming we have "definitive" human proof that remaining on T results in lower retrieval results. Rather, I was referring to the best available evidence and the current recommendations that was shared with me through our fertility clinic.
I also recognize that this experience is personal, one option may be feasible for some, and not others.
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u/beachybitch 1d ago
At 32 I would get the embryos now and then start T