Transgender individuals are just as likely to be interested in expanding their families as their cisgender peers in the LGBTQ+ community. But lack of research, limited knowledge in the medical community, and discrimination in healthcare settings all can create barriers to family forming for trans and non-binary people. Employers can support trans employees’ goals by offering LGBTQ+-inclusive fertility and family-forming benefits that provide specific resources for trans and non-binary employees. Below, we outline a few ways that employers can ensure their fertility benefit is inclusive of all gender identities.
Accessing knowledgeable care
Healthcare discrimination based on gender identity is common — in the U.S., 23% of trans people report being discriminated against in a healthcare setting. Lack of access to expert care is also a challenge; trans patients report that a lack of healthcare providers with expertise in transgender medicine is the largest barrier to access. Medical treatment specific to trans people is not taught in conventional medical curricula, and few physicians report a high comfort level with providing trans-specific care. This lack of knowledge and experience can lead to trans and non-binary people receiving harmful or inaccurate information related to their fertility.
On Carrot’s Baby Steps podcast, trans activist Trystan Reese shared that when he transitioned, his doctors told him that he would not be able to get pregnant. But after doing some research and talking with other transgender men about their experiences, he stopped taking testosterone and was able to get pregnant, ultimately giving birth to a healthy baby.
“I hear often that medical providers are still telling people that if they go on testosterone, it will render them sterile, which is not true,” Trystan said.
To help, employers can provide employees with access to providers who have experience working with the trans community. For example, Carrot Experts can help members find affirming, expert care, and all Carrot partner clinics and agencies are classified as LGBTQ+ friendly.
“Where possible, I find that reading patient reviews can also be super helpful — the opportunity to hear the perspective of other LGBTQ+ folks on the journey can be invaluable,” says Carrot Expert Amanda Hayden, LMSW, CD.
Hayden also recommends asking open-ended questions when reaching out to clinics or agencies. For example, “Can you tell me more about how your practice supports trans and non-binary intended parents?” tends to yield more information than “do you support trans and non-binary intended parents?”
Fertility preservation and testing
More research is needed to more fully understand trans fertility. Research suggests that for trans men and transmasculine people, taking testosterone can potentially suppress ovulation — though it’s not contraception. It can also possibly alter ovarian tissue and should not be used when actively trying to get pregnant, reproductive medicine expert Amanda Adeleye, MD, said recently in a Carrot webinar. For trans women and transfeminine people, estrogen and anti-androgens like finasteride can negatively impact the production and development of sperm, Dr. Adeleye said.
Because researchers don’t fully understand the long-term effects of hormone replacement therapy (HRT) on fertility, the best time to preserve fertility is before starting HRT. If someone has not preserved their fertility before starting HRT, however, that doesn’t mean they can’t have genetically related children.
“People who are trans identified in some way feel like they can’t have a genetic family. That’s the biggest myth,” said Dr. Adeleye. “It does sometimes take extra work, but for many, as long as you have gametes (sperm or eggs) available, whether frozen ahead of time or if they’re still around, it’s possible to make that happen.”
Trans-affirming healthcare providers can help patients determine their best options for fertility preservation and testing.
Language matters when talking about fertility and family forming. Many of the terms commonly used to discuss fertility, pregnancy, and family forming aren’t inclusive of trans and non-binary identities, so using inclusive language can be a powerful way to show support. The chart below provides a few common terms and more inclusive language options. You can find more guidance in our fertility language guide.
Creating a supportive work environment
Surveys show that trans employees are more likely to feel that their gender identity impacts how they’re perceived at work. For example, 53% of transgender employees feel that their gender identity is a barrier to future advancement at work. They’re also more than three times more likely to feel like they can’t talk about themselves or their life outside work. These experiences likely contribute to the fact that trans people are much more likely to frequently think about leaving their company (32% vs. 21% of cisgender people) and are more likely to consider staying at a company for less than one year (18% versus 8% of cisgender people.)
Providing fertility and family-forming benefits that meet the needs of trans and non-binary employees is one way to help gender-diverse employees feel seen and supported. Want to learn how Carrot can support all of your employees, regardless of sex, gender identity, or sexual orientation? Get in touch with us.