The Right to Parent: A Qualitative Exploration of Family Desires Among Transmasculine and Genderqueer Emerging Adults

Background and Purpose: It is estimated that 25-50% of all transgender individuals are parents (Stotzer et. al, 2014). Little is known about the family desires and formation experiences of younger transgender individuals. This study aims to elucidate the desires of transgender and genderqueer emerging young adults, particularly the experienced and anticipated barriers to actualizing these aspirations.

Methods: A qualitative study was conducted with 20 emerging adults (ages 18-29) identifying as transgender and/or gender non-conforming; assigned female sex at birth; and residing in Northern California. We conducted a thematic analysis concerning family planning and desires.

Results: Two groupings of participants emerged, characterized by their interactions with healthcare professionals: those who did not previously think about family planning until prompted by professionals; and those with pre-existing ideas of their future family.

In the first group, participants were introduced to the concept of family planning by healthcare professionals, primarily when seeking hormone replacement therapy (HRT) and were counseled on reproductive options during the informed consent process. Many participants felt overwhelmed by “having to choose” between starting HRT or postponing HRT to explore possible fertility options, such as egg preservation. Others deemed the questions inappropriate to the healthcare they were seeking or reported that egg preservation was a non-consideration owing to cost. A few participants noted that this study was the first time they had thought in-depth about family planning. Relationship status, financial circumstances, current HRT use and future surgery desires were important considerations for all participants. Among this group, there was a fervent call for more information on their family planning options.

In the second group, participants had pre-existingfamily desires when interfacing with professionals. Some participants had a desire to have a child that is biologically related to them and/or their partner(s), though the majority of these participants did not intend to carry a child. Those interested in pregnancy expressed uncertainty about how to actualize this desire and/or about the impact of HRT on their fertility. Others expressed plans or hopes for their partner to become pregnant. Many participants reported a desire to foster or adopt children. Commonly, participants with pre-existing desires expressed concerns around experiencing dysphoria during pregnancy, discrimination interfacing with professionals, and financial limitations.

Conclusions and Implications: The vast majority of participants referenced impediments faced by transgender and genderqueer emerging adults in family planning. It is clear that the lack of trans-specific reproductive health, family planning and fertility services, research, and provider knowledge are important barriers. There was an overwhelming desire and need for more trans-specific family planning research and accessible information, especially around the relationship between HRT and fertility. Without this information, even if family planning conversations are initiated, providers are not able to meaningfully support transgender and genderqueer clients. As participants overwhelmingly described financial limitations and discriminatory experiences in the medical system, social work has an important role to play in advocating for and implementing policy and systems-level reforms.