Even though it's not listed on the offered treatments of the current care pathway document, fertility preservation is something that has to be considered prior to hormones, and may not be raised by other parties until this point. So, you could wait around for ages until you're finally seen by the endocrinologist... only to get asked if you've considered what will happen to your fertility, and whether you have already explored those options, and choosing to have your eggs or sperm frozen means that your journey of seeking hormones gets paused.
Fertility isn't something many people will consider on their own, especially young people for whom parenthood feels very far away. To do so is to prioritise your future-self's chance for a family using your own DNA, over your current-self's desire to start hormones and further align their gender presentation with their gender identity, and it takes a mental toll.
Knowing it is something you need to think about from the get-go, just from glancing at a diagram, will be really helpful. It will make it clear that it can be explored, whilst on the waitlist for a hormone-appointment, via your GP (with your diagnostic letter from an NHS GIS, it is possible to do so without if your are waiting but this may prove more difficult).
I used these pages to help me determine what 'stops' need to be on the fertility lines, and how they would differ depending on whether it was eggs or sperm being collected and stored:
I realised that for egg freezing you would need to go into hospital (as I was), as even though it is a minor procedure that is a day case, you are still either sedated or out under using general anaesthetic and monitored after before discharge. Whereas for sperm storage, you go to a clinic or bank to make that deposit.
This made me consider whether I should create some kind of symbol for where going to a hospital is necessary - so for egg freezing, top surgery, and all lower surgeries.
My NHS egg freezing journey - as the first trans man in the North West!
Egg freezing is not something I had considered until I was in my first private appointment with Gender Care back in September 2017. I was diagnosed with gender dysphoria, and based on the blood tests I had already had was told that after a course of vitamin D supplements I could start hormones unless I wanted to pursue fertility preservation.
Speaking to my GP, my case was submitted to a board for approval, and I was the first transgender man to receive NHS funding for fertility in the North West area, and the first transgender patient at Liverpool Women's Hospital. This meant I had a yellow sticky note on my file that reminded whoever was reading it that I was trans and used he/him pronouns - this didn't avoid slipups completely, but it did lessen them and people tried, and as I was not on hormones yet and there was a lot of discussion around female anatomy, eggs, internal ultrasounds etc. I could understand and forgive the accidental misgendering.
The process was approximately 3 months start to finish, we had to wait for the start of my period (which I missed one with the Christmas stress in a retail job at the time) so that prolonged things, and then I could start the Follicle Stimulating Hormone (FSH) injections that would increase the amount of eggs my ovaries would produce, so that more can be collected and stored. I had to have vaginal ultrasounds and blood tests to monitor the ovaries, and when it seemed like they had reached the optimum window I had to have a final injection of a hormone called human chorionic gonadotrophin (hCG) to help my eggs mature.
I was put under for the actual procedure of collecting the eggs, but I do have some trauma of the fact that I wasn't fully sedated and could still hear the doctors and feel everything as they started to move me and poke before I went out. So when it came to top surgery, I had to really stress to the doctors that even if they think I'm out of it, please just wait another few minutes. In total they collected 17 eggs (which is a lot apparently), and they were frozen in February 2018, meaning that the NHS will pay to have them stored until February 2028 and then I will have to pay - because there's no way I'll be ready for kids at that point!!
It was definitely worth pausing the hormone journey for with how successful it was, but the process did delay my hormone journey by approximately 7 months, which for some people this time delay would not feel worth it.
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