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.

This chapter returns to the CVC study in Grenada. Faced with pressure to complete their ambitious six-country size estimation study before their grant ended and donors transitioned out of the Caribbean, CVC focused its efforts on strong engagement of community field workers, who had the trust of their peers and could accompany them in overcoming the numerous barriers to participation. Working through networks of trusted community gatekeepers, CVC and local partners strengthened the role of community-based organizations in the research. The data was difficult to get, but the work of indigenous field workers enabled the researchers to gather granular data about previously undocumented populations including transgender people, as well as documenting incest and other hidden forms of gender-based violence, and to form stronger bonds between civil society and health officials.