A NOTE ON FERTILITY AND MTF HRT
Last fall, my partner and I decided we would start trying to have a
child. Whereas I am a trans-woman who's been on HRT since 2018 our
path towards parenting is complicated, to say the least. Nonetheless,
we have a path and that's what counts. Whether it leads to a tot or
two is not up to me or her. Life is unpredictable and I wouldn't want
the plot spoiled anyways.
What I do know is that my partner and I want to conceive with her egg
and my sperm. But a well known side-effect of HRT is that it causes
sperm production to slow down or stop--a person effectively becomes
infertile. A test confirmed this fact for me: my sperm was bunk. But:
there was a possibility that it could get better. If I temporarily
stopped taking my HRT medication, maybe my fertility would
return. There's not a lot of information to confirm this outcome, but
anecdotes dotted throughout the internet suggest that for some
trans-women it has been possible. And my situation seemed hopeful: I'd
been on HRT for ~3 years, having started in my late twenties well
after my primary-secondary sexual characteristics had
developed[1]. What would I have to lose?[2]
I decided I'd give it a try. Before being trans or a woman I am
curious. Part of me wanted to add to the anecdotes--either saying it
didn't work or that 🤞 it did. So I decided I would plunge back into
"boy-mode" for a few months and see what happened. I wasn't looking
forward to that experience. But like I said: I wasn't entirely opposed
to it, either. To bolster my chances of producing good sperm, I also
decided I'd stop taking baths, hot showers, and wearing underwear. The
presence of heat around the testicles seems to be one of the most
significant factors that negatively affects sperm quality. So on
October 9, 2021, I skipped the underwear drawer, stayed stinky, and
stopped taking my HRT medication[3].
Timeline of changes
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Here's what happened next:
- Oct 9: small, sudden and short lived feelings of euphoria
- Oct 12: areolas not as sensitive
- Oct 13: beginning of nocturnal penile tumescence
- Oct 16: noticeable increase in seminal fluid discharged after
ejaculation
- Oct 17: noticeable increase of fluid after next-day ejaculation
- Oct 18: areolas hardly sensitive at all
- Oct 18: stomach no longer sensitive to coffee
- Oct 28: noticeable increase in libido and shift in areas of pleasure
- November 1-30: increasing feelings of irritability
- November 17: significant hair regrowth on face; follicles are thicker
- November 20-30: spontaneous erections
- December 1-19: noticeable growth of hair on chest
- December 20: end of irritability caused by shift in hormones
- December 1-31: further increase in libido
- January 8: loss of weight
- January 1-30: noticeable increase in appetite
Reflections and outcomes
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Overall, the experience was more emotionally taxing than I'd
anticipated. I was extremely irritable for the first two months of
being off HRT. An endocrinologist would later explain that this was in
part due to my body experiencing a lack of both female and male
hormones--one was being flushed from my system while the other was
slowly returning to production. Then, when my emotions started to
stabilize my body started to change. That was unsettling, too. But
throughout the process my partner was incredibly supportive, patient,
and understanding. The notes above omit details after January because
I eventually settled into what I want to call an "uncomfortable
equilibrium" or "casual dysphoria". This lasted until April, when I
eventually returned to HRT. But I'm skipping ahead. Because it was
only three months after I'd stopped HRT[4] that my partner and I got
the news we'd been waiting for...
No, it's not that she was pregnant (psych!). It was the results of a
sperm collection and analysis performed by a fertility clinic. They
reported the following:
- The sample has progressive motility with 15% "type-A" sperm
- The sample contains 13 million sperm per millimetre
In other words, I had regained my fertility! Better still: the sperm
sample could be stored and used for IUI[5] should our attempts at
an unassisted pregnancy fail. Hearing that second outcome was, in many
ways, the greater relief. My partner and I previously met with the
same clinic to discuss an assisted pregnancy via IVF[6], because
the sperm I "had on tap" from a collection in 2018 could be used with
this method. But IVF is far more costly, physically invasive, and
time-consuming than the relatively "tame" IUI method. (Obviously, we
were hoping to avoid either method, but understood the chances of an
unassisted pregnancy were low, given our situation and timeline.)
Suffice it to say, we got good news. Sadly, it wouldn't last long.
There and back again
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About three months later, in March (can't remember the exact date), I
went for another sperm collection and analysis. The quality of that
sample was /terrible/. The sperm was only good enough for IVF, which
is
also to say that the chances of an unassisted pregnancy occurring were
low (we'd been trying all the while). I was quite taken aback by these
results, since the previous sample had been so good. But I must admit
that the decline may have been my own doing[7]. It took me
the better part of a month to process the results and decide what to
do next. Since stopping HRT in October, I had my partner's full
support to start again at any moment. Realizing that we'd gotten what
we wanted out of this experience--banked sperm that we could use--I
decided to get back on my medication, which I did at the beginning of
April. It feels great to be back 👧.
Footnotes
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Footnotes
_________
[1] You know what I mean.
[2] Turns out mostly facial fat and emotional stability.
[3] Estradiol (4mg) and spironolactone (50mg).
[4] January 14, 2022, to be precise.
[5] Intrauterine insemination: sperm that have been washed and
concentrated are placed directly in your uterus around the time your
ovary releases one or more eggs to be fertilized. (Mayo Clinic)
[6] In Vitro Fertilization: involves combining eggs and sperm
outside the body in a laboratory. Once an embryo or embryos form, they
are placed in the uterus. (WebMD)
[7] What changed? Heat 🔥. I started taking longer (and hotter)
showers (it was winter, after all!) But also: the clinic informed me
that sperm quality naturally varies over time. Even in "healthy",
"fertile" bodies the motility and concentration will change.