Trans people who transition medically are typically hoping to live their lives simply as members of the sex with which their gender corresponds but may wish to make full use of the capabilities of their physical bodies, which may differ from typical male or female bodies. This chapter, co-authored by a trans man who is a transgender health advocate and a trans woman who is a physician, provides an overview of the kind of physical changes that are experienced by trans people, both those who transition from female to or toward male and those from male to or toward female, and alerts gynecologists and other medical healthcare professionals to the trans person’s perspective in clinical encounters.

Ovaries are the reproductive organs of women, producing the gametes and sex hormones.

The production of sex hormones is important for the regulation of ovarian function and menstrual cyclicity. Trans men undergo testosterone treatment or/and gender re-affirming surgery in order to overcome gender dysphoria. This treatment might result in the cessation of the normal ovarian function. For trans men that wish to retain their fertility options, ovarian function remains a prerequisite for genetically related offspring. Fertility treatments for trans men may occur before or in between testosterone treatment. Treatments following testosterone supplementation may have an effect in the proper ovarian function. This chapter deals in detail with the effects of testosterone on the ovarian anatomy and physiology.

Fertility preservation has become a hot issue in transgender medicine. Today counseling on this aspect prior to the start of treatment is regarded mandatory. However, reproductive consequences and options in the context of gender-affirmative treatment remain far from clear. Transgender people face multiple medical and legal problems when trying to achieve parenthood using the help of assisted reproduction. This is a result of two main causes: (1) In many cases, the knowledge of fertility preservation is not available to the concerned parties before gender reassignment, as well as the methods of fertility treatments afterwards. There is also a lack of such knowledge within the health system; (2) National laws do not take into consideration the special needs and challenges of this patient group as they consist solely of general rules for cis couples trying to conceive.

This chapter offers a list of assisted reproductive technology (ART) methods available for transgender people and points out their medico-legal challenges. The authors think ahead and think through the consequences of various constellations for assisted reproduction. The chapter is an inexhaustible source for providing up-dated information on fertility options for trans- and gender diverse people. Moreover, this chapter points to the numerous legal weaknesses in legislation on reproductive issues and the discriminatory consequences for people beyond the gender binary.