Unsolved mystery: Trans women have significantly lower semen quality than cis men – before starting HRT

Sperm banking is the recommended method of fertility preservation for trans women prior to medical transition (Coleman et al., 2012), as cross-sex hormone therapy can impair fertility, and gonadectomy (removal of the testes during vaginoplasty or orchiectomy) results in permanent sterility. Semen cryopreservation before starting hormone therapy is a precautionary measure, as the impact of HRT on fertility can be highly variable between individuals – contrary to certain myths and misconceptions, taking hormones does not reliably produce permanent or even temporary sterility in trans women. In a literature review, Schneider et al. (2017) reported:

Whereas three publications described a marked reduction of the spermatogenic level in all patients examined, eight publications reported inconsistent results. Histological analyses showed highly variable outcomes from qualitatively normal spermatogenesis and undisturbed Leydig/Sertoli cell morphology to full testicular regression with severe cellular damage and hyalinization.

This wide variation in the effects of HRT on sperm production makes clear why trans women cannot rely on cross-sex hormones as a method of birth control; trans women engaging in sexual activity that could result in pregnancy should still use an appropriate contraceptive method. Continue reading “Unsolved mystery: Trans women have significantly lower semen quality than cis men – before starting HRT”