The desire for parenthood and biological children among adult transgender and gender-diverse individuals seeking gender-affirming care

Objective
A small number of studies primarily from outside the United States have reported parental desire among transgender and gender-diverse (TGD) individuals, but most studies have not specifically reported desire for a biological child.1 Most of these studies found that genetic relatedness was not important for most TGD individuals who desire a child.1 The rates of parenthood among TGD individuals have varied from 3% to 30%, including 18% from the large 2015 US Transgender Survey.1, 2, 3 This study aimed to characterize the desire for a biological child among adult TGD patients seeking gender-affirming care in the United States.

Study Design
This retrospective review relied on data from the clinical notes of 255 TGD patients seen in an adult endocrinology clinic in Boston, Massachusetts, between 2020 and 2024 (eMethods).

Results
Of the medical records reviewed, 94% contained information on the desire for a biological child. The mean age was 29.7 years, 121 of 255 individuals (47%) were assigned female at birth, 75 of 255 individuals (29%) identified as nonbinary, and 145 of 255 individuals (57%) were naive to gender-affirming hormone therapy. For individuals assigned female at birth, 6 of 121 (5%) had a biological child, 3 of 121 (3%) had a nonbiological child, 9 of 121 (7%) desired a biological child, and 25 of 121 (21%) were unsure whether they desired a biological child (Table). For individuals assigned male at birth, 22 of 134 (16%) had a biological child, 3 of 134 (2%) had a nonbiological child, 13 of 134 (10%) desired a biological child, and 19 of 134 (14%) were unsure whether they desired a biological child. The desire for a biological child was similar among the various age groups between 16 and 39 years and was not associated with the presence of a mental health diagnosis, use of a psychiatric medication, or previous hormone use (Supplemental Table). The rates of orchiectomy, hysterectomy with or without oophorectomy, and fertility preservation are presented in the Table. Individuals assigned male at birth were more likely to be older, to have a biological child, and to have completed or desired fertility preservation than those assigned female at birth (P<.01 for all). Individuals assigned female at birth were more likely to be taking a psychiatric medication and more likely to have anxiety, depression, and/or posttraumatic stress disorder than those assigned male at birth (P<.04 for all).