Overview

Fertility is one of the most consequential and least understood outcomes of medical transition. Puberty blockers, cross-sex hormones and gender surgeries each affect the ability to have biological children in different ways. Some effects are temporary and often recover after stopping. Others are uncertain. Some, like removing the ovaries or testes, are permanent.

This page covers what the published evidence says about each intervention, why so few young people preserve their fertility before treatment, the consent problem this creates, and what detransitioners describe: grief, fear, relief and, for some, pregnancies after stopping hormones. It also covers how trans-identified people talk about fertility, because their perspectives show how these decisions are framed at the point of treatment.

This page is not medical advice. Anyone worried about their own fertility should speak to a fertility specialist or endocrinologist who can test them.

How each intervention affects fertility

Puberty blockers followed by cross-sex hormones

Puberty blockers (GnRH agonists such as leuprorelin) can be started at Tanner stage 2, the first physical signs of puberty, which can be as early as age 9. They are often described as a reversible pause. On their own, stopping them should allow puberty to resume. But the great majority of children who start blockers go on to cross-sex hormones. A review in the Journal of the American College of Clinical Pharmacy reported that over 95% do (Jorgensen 2022).

This combination is the key fertility problem. If blockers are started in early puberty and followed directly by cross-sex hormones, the child's own sex hormones never drive sperm or eggs to maturity. Authors arguing for the child's "right to an open future" note that such children, who mostly go on to hormones, "will not be able to have biological offspring" (Archives of Sexual Behavior 2024). Because no mature sperm exist, sperm banking is not possible. The only option is freezing immature testicular or ovarian tissue, which is still experimental in males (Frontiers in Endocrinology 2025).

Tissue studies point the same way. A Dutch study of testes removed during genital surgery in males on blockers and estrogen found mature sperm in only 4.7% of samples, all from people who had started treatment at Tanner stage 4 or later (de Nie et al. 2022). In those who started at Tanner stage 2–3, only immature stem cells were found. A 2024 Mayo Clinic preprint reported mild to severe testicular atrophy in puberty-blocked boys, with germ cells arrested at the stem-cell stage and gene expression that still looked prepubertal after long-term treatment (Murugesh et al. 2024). The authors raised concerns about whether full reproductive recovery is guaranteed. It is a small, early study that has not been confirmed, but it questions the claim that blockers are simply a "pause."

Detransitioners who were blocked young describe this as a lasting loss, not a pause:

I am a eunuch who never fully matured as an adult male. I will never truly be a man. —[deleted], describing treatment as a teenager

I got Puberty blockers and HRT Since I was a child and now I have medical issues with my ability to get kids… —Nanachiowo, detrans male

The same pathway also affects genital development and later sexual function. That is a separate harm, but it comes from the same decision.

Testosterone in females

Testosterone usually stops menstruation and suppresses ovarian function. It does not reliably stop ovulation and is not a contraceptive. Trans and detrans commenters alike warn others about this. For a long time many clinicians told patients that testosterone would sterilise them. Several detransitioned women describe being told exactly that before they conceived.

What the evidence shows

Evidence on fertility after testosterone is limited but more reassuring than earlier assumptions:

• A survey of 41 trans-identified females who became pregnant found 61% had used testosterone beforehand, and most conceived with their own eggs (Light et al. 2014).
• A systematic review of egg retrieval after long-term testosterone found successful retrievals even after more than a decade of use, usually after stopping for a few months (2023 systematic review).
• A small US fertility-clinic study found no correlation between time on testosterone and the number of eggs retrieved (F&S Reports 2023).
• A 2023 review in Human Reproduction tabulated pregnancies and live births after testosterone but stressed that the data consists of small cohorts and case series (Human Reproduction 2023).

These studies have clear limits. Samples are small and self-selected, and most measure egg yield, not long-term ovarian health. Almost none follow people who started testosterone as adolescents, or who went straight from blockers to testosterone without completing puberty. Detransitioners also report effects not captured by egg counts, such as vaginal and uterine atrophy, pelvic pain and pelvic floor problems. In a UK qualitative study of detransitioned women, worry about infertility and uterine atrophy was among the long-term health concerns that contributed to their decision to stop (Lomax & Butler 2025).

Cycles returning after testosterone

Accounts on /r/detrans vary widely. Some women describe periods returning within weeks, others after many months, and some report hormone levels taking years to settle. (See testosterone cessation for the wider process.)

I was 4 years on T and my cycle took 10 to 11 months to return and waiting for it felt like forever! —idkreddituser11, detrans female

I went on it for 5 years and it took 2 years before I had my normal hormone levels back… It took some time but I was able to get pregnant and now have a healthy baby. —Upstairs_Wasabi5340, detrans female

Pregnancies after detransition

A recurring theme in the subreddit is relief: women who believed they were sterile and then conceived, sometimes unexpectedly and soon after stopping.

I also got pregnant around two months off of T, and after being told that I was infertile by a doctor… —Total_Address4630, detrans female

like you I was on t from 17-22. I had IVF egg retrieval last year and was able to produce 7 genetically normal embryos. —pipermaru84, detrans female

These are encouraging, but they come from people who conceived and chose to post about it. Others describe miscarriages, delivery complications they link to pelvic floor changes, or years of trying. One woman who did conceive pushed back against the impression that recovery is the norm:

…the reality is that many (if not most) females taking testosterone will eventually lose their fertility, even if they don't have a hysterectomy (which many do). We are really fortunate. —DetransLaura, detrans female

No study has measured how many detransitioned women conceive, how long it takes, or how outcomes differ by age at starting testosterone. Both the optimism and the pessimism in these threads go beyond what the evidence can confirm.

Estrogen and anti-androgens in males

In males, estrogen and testosterone blockers suppress testosterone and, with it, sperm production. A study of testicular function in males on these hormones concluded that treatment leads to complete suppression of sperm production in most patients whose testosterone is kept in the female range (testicular function study).

Recovery after stopping is possible but unpredictable:

• A Dutch case series documented sperm production returning in nine males who stopped hormones, four of whom conceived naturally with partners. The authors called this preliminary and said larger studies are needed (de Nie et al. 2023).
• A US case report described three patients on estrogen for 6–21 years who all had no sperm on standard testing. One still had none 10 months after stopping (Eid et al.).

Detransitioned men on /r/detrans report the same range. Some describe full recovery:

I was on full hrt for 4 years and my fertility came back 100%. Don't make any assumption, you can get your levels checked. —AlviToronto, detrans male

Others warn that returning function is not the same as fertility:

Producing an actual ejaculate doesn't necessarily mean that there are sperm cells in there. The only way to know if your fertility has been affected is to get your fertility measured in the form of a semen analysis. —Hedera_Thorn, detrans male

The estrogen cessation page covers the wider recovery process.

Surgeries that end fertility

Surgery removes the uncertainty. Hysterectomy ends the ability to carry a pregnancy. If the ovaries are also removed (oophorectomy), eggs can no longer be produced and lifelong hormone replacement is needed. Orchiectomy, which is also part of vaginoplasty, permanently ends sperm production.

Commenters describe how these surgeries were offered as routine or practical: a fix for pain caused by atrophy on testosterone, a way to stop taking blockers, or simply the expected "whole package."

I took my doctor's suggestion to get a hysterectomy. I was really happy with my decision for years, but after about a year into detransitioning… I starting to hit an age where being a parent feels like an experience I'd be ready for. —MangoProud3126, detrans female

Whether the ovaries were kept matters a great deal. Women who kept them can still have genetic children through IVF (in vitro fertilisation) and surrogacy, though at great cost:

I also had a hysterectomy, but I ask the surgeons to keep my ovaries. I can still have biological children but through surrogacy which is not going to be cheap. But it still kills me that I technically neutered myself. —ThatGirlChyna, detrans female

A man who had genital surgery at 18 described a moment of doubt that he set aside:

I had the option to freeze my sperm prior however was freshly an adult and financially unable to at the time… choosing to recognize losing my fertility was just one those transition-related sacrifices I had to make. Oh how I so regret that. —[deleted]

Breastfeeding after mastectomy

Mastectomy does not affect fertility, but it usually ends the ability to breastfeed. The most common technique, double incision with free nipple grafts, removes the glands and cuts the nipple off from the milk ducts. The first published case report of breastfeeding grief after detransition described a woman who became pregnant after detransitioning and grieved her inability to feed her baby. Her maternity care providers did not understand her situation (Gribble et al. 2023). The authors noted that breastfeeding is largely missing from counselling and consent guidance for chest masculinisation surgery. As a single case it cannot show how common this experience is.

Detransitioned women describe this loss as being about their children as well as themselves:

Breastfeeding is a really hard one, because it's not just about me, it's also about my kids, too… I'm currently in my second pregnancy and some of the residual breast tissue swells and gets sore. —Miseracordiae, detrans female

Fertility preservation and its low uptake

Guidelines, including the Cass Review (England's independent 2024 review of youth gender services), recommend that anyone considering a medical pathway be offered fertility counselling and preservation first (Cass 2024). In practice, counselling is common but preservation is rare.

• In a large US gender clinic, 72 of 73 adolescents were counselled about fertility before hormones, but only 2 attempted preservation. 45% mentioned plans to adopt and 21% said they had never wanted children (Nahata et al. 2017).
• A systematic review found a Canadian clinic where none of 79 counselled adolescents chose preservation. Across studies, uptake was 0–16.7% for trans-identified females, and the review noted that the urgency to start hormones often overrode the wish to preserve fertility (Baram et al. 2019).

Why so few preserve

The barriers are both practical and psychological:

• Invasiveness. Egg freezing means stopping testosterone, daily hormone injections, repeated scans and a surgical retrieval. For a gender-distressed girl, this means going through the exact processes she is trying to escape. Sperm banking requires masturbation to produce a sample, which some distressed adolescents find impossible.
• Delay. Preserving fertility means stopping or postponing hormones, which can feel unbearable to someone in distress.
• Cost. Egg retrieval and long-term storage can cost thousands, and insurance coverage is patchy.
• Developmental timing. Children blocked at early puberty have no mature gametes to freeze at all.

Trans-identified people describe the same barriers. Some decide the process is not worth it:

For me, the overall process wasn't worth it. I personally don't have strong feelings about needing biological children. —Maleficent_Tone8120, trans man (FTM)

I live in the USA and it was prohibitively expensive so I did not do any gamete preservation. I regret every day that I got my hysto so soon after transitioning… —ConnotationalRacket, trans man (FTM)

Preservation is also not a guarantee. A small number of frozen eggs or sperm vials gives a limited number of attempts, and IVF and surrogacy are physically and financially demanding. A man who banked sperm before transition put it this way: "once you're infertile all you have is a limited amount of vials" (ICircumventPermabans, questioning own gender transition).

The consent problem

The deepest issue is not medical but philosophical. Infertility is a loss whose meaning usually appears only later in life: with a loving partner, in one's late twenties or thirties, when friends start having children. A 12-year-old, or even an 18-year-old in acute distress, is asked to weigh a future self they cannot yet imagine. One participant quoted in Dutch research (Vrouenraets et al. 2023) asked whether children of that age "can even begin to imagine what it really implies" (Archives of Sexual Behavior 2024). This is why critics argue that informed consent to fertility loss is not meaningfully possible for children (The New Bioethics 2022).

The data shows how teenagers answer the question: many say they never want children or would adopt (Nahata et al. 2017). Detransitioners repeatedly describe giving the same answer and later finding it was a stage of life, not a lasting preference:

Pre-T I was absolutely sure I would never ever want children… I had no idea that I would ever want this more than anything back when I was 17-18 and making irreversible decisions about the rest of my life. —shittytoyota, detrans female

I went from "no way do I want kids" in my teens/early 20s to very much wanting kids in my thirties, and that's a pretty common life pattern. —No_Improvement4310, detrans male

Three dynamics make this worse:

• Dysphoria colours the answer. For a girl who is disgusted by her female body, pregnancy can feel like the ultimate violation. Rejecting motherhood can be a symptom of the distress being treated, not a stable value. One woman wrote that she was told she would be "too dysphoric" to carry a child, and was later left without that option (Worried-Rain-1532, detrans female).
• Social reassurance. Detrans women describe concerns being brushed aside with reassurances that it was "worth it" or that a future partner could carry the child (throwawayforthebestk, detrans female).
• Missing information. Some say fertility was never mentioned. Others were told the opposite of the truth in either direction: that testosterone would definitely sterilise them, or that blockers were fully reversible.

The doctors mentioned nothing about fertility. I never asked about it but even the "informed consent" mentioned nothing about it. —Space-A1ien, detrans female

Grief over lost fertility

For those who did lose their fertility, the grief is often described in physical terms: dreams of babies, jealousy of pregnant women, pain at the sight of infants. Many describe it surfacing years after the decision, often triggered by a relationship.

I recently got married to an amazing man… But getting married has also made me realize the horror of what I have done and that I cannot have a baby with him. —transformed2016, detrans female

I also have reoccurring dreams where I have a baby and I wake up very sad each time. I got a hysterectomy at 16 years old. —notaplant999, questioning own gender identity

This grief has some distinct features:

• Self-blame. Unlike infertility from illness, this loss followed a choice the person made, often as a minor or young adult. Commenters describe guilt toward a partner, toward the children they will never have, and toward their own younger selves.
• Grief for things beyond pregnancy. Some women grieve the loss of periods, female bonding around pregnancy, and breastfeeding. Some men grieve the loss of fatherhood and being part of a male line.
• "Just adopt." Commenters note that this well-meant advice can feel dismissive. Others find real peace in it: one woman adopted two children from infancy and has "never felt less than" (L82Desist, detrans female).
• Wanting a child as a reason to detransition. For some, the wish for children is part of why they stopped. A detrans male wrote that "wanting a child was a large aspect of me detransitioning" (sentientmassofenergy, detrans male).

Some find a way through. One woman who had a hysterectomy at 19 described being "a mess" for months after detransitioning, then reaching a point where it "doesnt feel like a black hole in my heart anymore" (mushroomgf, detrans female). See healing and recovery and transition regret for more on this process.

Trans perspectives on fertility

Trans-identified people are not uniform on this. Many say biological children do not matter to them and that parenthood can be built in other ways. Others value fertility and have children by pausing hormones. In trans communities, trans-identified females who carry pregnancies call themselves "seahorse dads":

I started testosterone almost 15 years ago and was always against having my own kids until I had to stop T for a bit… now I'm 39 weeks pregnant and super excited to be a dad! —dacupcakeman, trans man (FTM)

These accounts confirm two things detransitioners also report. Fertility after testosterone is often possible. And pregnancy can be very hard for someone with a male identity: one trans man called it "absolute hell in the sense of dysphoria" (Kirian666, trans man (FTM)). Among trans women, the common advice is blunt: "if you want children, assume infertility as soon as hrt is in your system" (scourge_of_somewhere, trans woman (MTF)).

These perspectives deserve respect. Adults who weigh the trade-off with full information and choose transition are making their own decision. The problem detransitioners raise is different: the decision is often made by adolescents, under distress, before they can know what they will want, with blockers that may close the door before preservation is even possible.

Summary

• Fertility effects range from temporary (hormones after a completed puberty) to permanent (gonad removal), with puberty blockers followed by cross-sex hormones the most likely to prevent fertility from ever developing.
• Evidence on recovery is encouraging for some people but based on small, self-selected samples. It cannot predict any individual outcome.
• Fertility preservation is widely recommended but rarely used by adolescents, because it is invasive, costly, delaying and sometimes impossible.
• Many detransitioners describe a desire for children that appeared only in adulthood, and grief, guilt and fear when that desire meets a body that was altered too early.
• Pregnancies after detransition do happen and bring great relief, but they do not prove the risk was small for others.

More first-hand accounts are in the video archive, the research is collected in the study archive, and the support directory lists detrans support groups and therapists.

References

• Murugesh et al. (2024). Puberty Blocker and Aging Impact on Testicular Cell States and Function (preprint). study page, source.
• Lomax, J. & Butler, C. (2025). Narratives of Adults Registered Female at Birth Who Started a Medical Transition and Later Detransitioned. Archives of Sexual Behavior. study page, source.
• Cass, H. (2024). Independent review of gender identity services for children and young people: Final report. study page.
• Gribble, K. D., Bewley, S. & Dahlen, H. G. (2023). Breastfeeding grief after chest masculinisation mastectomy and detransition: A case report with lessons about unanticipated harm. Frontiers in Global Women's Health. study page, source.
• Nahata, L. et al. (2017). Low Fertility Preservation Utilization Among Transgender Youth. Journal of Adolescent Health 61(1):40–44. source.
• Baram, S. et al. (2019). Fertility preservation for transgender adolescents and young adults: a systematic review. Human Reproduction Update 25(6):694–716. source.
• de Nie, I. et al. (2022). Histological study on the influence of puberty suppression and hormonal treatment on developing germ cells in transgender women. Human Reproduction 37(2):297–308. source.
• de Nie, I. et al. (2023). Successful restoration of spermatogenesis following gender-affirming hormone therapy in transgender women. Cell Reports Medicine 4:100858. source.
• Eid et al. Extended sperm search and microfreeze for fertility preservation after long-term hormone therapy in transgender women: a report of three cases. AME Case Reports. source.
• Characterisation of testicular function and spermatogenesis in transgender women. source.
• Light, A. D. et al. (2014). Transgender men who experienced pregnancy after female-to-male gender transitioning. Obstetrics & Gynecology 124(6):1120–7. source.
• Preservation of Fertility in Transgender Men on Long-Term Testosterone Therapy: A Systematic Review of Oocyte Retrieval Outcomes During and After Exogenous Androgen Exposure (2023). source.
• Fertility treatment outcomes in transgender men with a history of testosterone therapy (2023). F&S Reports. source.
• Reproductive capacity after gender-affirming testosterone therapy (2023). Human Reproduction. source.
• Jorgensen, S. (2022). Puberty blockers for gender dysphoric youth: A lack of sound science. JACCP. source.
• Puberty Suppression for Pediatric Gender Dysphoria and the Child's Right to an Open Future (2024). Archives of Sexual Behavior. source.
• Fertility preservation: is there a model for gender-dysphoric youth? (2025). Frontiers in Endocrinology. source.
• Puberty Blockers for Children: Can They Consent? The New Bioethics. source.