Sexual & Reproductive Health

Information about sexual health and reproductive planning for trans and gender diverse people.

Sexual health

Many trans people become involved in sexual relationships. Many trans people do not. This page provides information specific to trans people, while respecting those who identify as asexual, demisexual, or on the asexual spectrum.

It is not always easy for trans people to find accurate and inclusive information about sexual health and sex.

There are many changes that may come along with a social transition, including shifts in one’s sexual orientation and comfort with a changing sense of self. With a medical transition, trans people may experience new sensations with hormonal changes and different opportunities because of access to surgeries.

You may choose to discuss your trans identity with partners or dates. You are entitled to have safer, enjoyable sex where your body and identities are respected.

Resources

Online

Opt (Options for Sexual Health) – a free and confidential service for people living in BC. You will reach nurses, counsellors, and sex educators who can answer trans-specific questions about sexual health

Print guides

Note: These resources contain images or wording that some may find graphic or even explicit.

Trans Women: Trans Health Matters – a guide to sexual health for trans women (Terrence Higgins Trust, UK, 2012). Available for download from Rainbow Health Ontario
Transmen: Trans Health Matters – a guide to sexual health for trans men (Terrence Higgins Trust, UK, 2012). Available for download from Rainbow Health Ontario
Brazen: Trans Women Safer Sex Guide – a guide for transwomen. Available for download from CATIE: Canada’s Source for HIV and Hepatitis C Information
Primed: The Back Pocket Guide for Trans Men and the Men Who Dig Them – a guide for trans men. Available for download from Rainbow Health Ontario

Reproductive health

Many trans people may be interested becoming a parents and having children. There are many options for doing so including pregnancy, surrogacy, adoption, fostering, or fertility options.

Planning for reproduction

If you are planning on having children, or wish to explore the option of having children in the future, reproduction options may be an important factor to consider depending on (before/while moving forward with) the gender affirming goals you may have.

Every person will have a unique journey in their decision making and planning around reproduction, depending on their bodies. Some may choose to pursue gender-affirming care before reproductive planning, and others may decide to post-pone accessing hormone therapy or surgery until they have a reproductive plan in place.

Choosing to move forward with starting hormones or having lower surgery does not change your ability to become a parent, however it may limit some of the reproduction options available to you.

Discussing your thoughts about reproduction planning with your partner, family or care provider may help clarify available options, including timelines related to reproductive cell preservation and accessing gender affirming care.

What are the processes and costs related to preserving my reproductive cells?

With hormone therapy or gender-affirming surgery, there are additional considerations if you wish to freeze your reproductive cells (sperm or eggs).

Sperm

After a three-month break from feminizing hormones, sperm should be back to 80% of previous levels. By six months sperm should be 100%. If fertility has not resumed after six months, it is not likely to return.

The processing fee for sperm is about $200. The storage costs are about $200 per year.

Eggs

There is no set timeline for how long you can be on testosterone and still be able to take a break and produce eggs. Generally, the younger you are and the less time you have been on testosterone the better the outcomes. If you have been on testosterone for 10 years or more, or are over age 40, you are less likely to produce viable eggs.

The process for harvesting eggs is more complicated than for collecting sperm. You would take a break from hormones, then take shots twice a day for 10 to 14 days to stimulate multiple eggs. During a short office visit at a fertility clinic, a probe would be used to harvest the eggs from the vagina. (You would be sedated during the procedure.)

The cost for the procedure is about $8,000, plus $3,000 for medications.

Once the eggs are removed, they are frozen and can remain frozen for years, until you or your partner is ready to try to get pregnant. The fertilization and implantation process costs about $3,000 for each attempt.

How do I choose a fertility clinic or health care provider?

You might want to ask other trans people for recommendations for a fertility clinic or health care provider. Feel free to contact us for recommendations of clinics or providers in your area. We will do our best to connect you with someone.

When you are choosing a clinic or care provider, you might want to ask them about their experience with trans patients, including:

How many trans patients have you treated before?
What are your success rates?
Are you familiar with chest-feeding for transgender people?

You can also take a look at their office or clinic waiting room to see if they have inclusive materials or review their forms to see if they are gender inclusive.

What happens if I get pregnant while taking testosterone?

It is possible to get pregnant while on testosterone, so contraception is recommended. You can discuss the best contraception options for you with your primary care provider.

If contraception fails, see your health care provider immediately. There are risks to a fetus if you are taking testosterone, especially during the first trimester.

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