Fertility preservation

Fertility preservation, in the context of the trans and nonbinary community, means any steps taken by individuals to retain the option of having children who are biologically related to them. Some types of hormone therapy or surgery will reduce or eliminate fertility either reversibly or irreversibly. Physicians often do not inform their patients about this, especially younger patients, although discussing it is recommended to be always done.

Some countries and states require transgender people to be sterilized (have their ovaries or testicles removed) in order to be legally recognised as their self-identified gender.

Individuals who take puberty blockers and then seamlessly move to taking adult hormone therapy may not have their bodies develop sufficient "reproductive material", leaving them permanently infertile.

Fertility preservation for people who were assigned female at birth
Masculinizing hormone therapy decreases ovulation and stops menstrual bleeding. However, people on masculinizing HRT may still become pregnant.

In patients who have at least begun puberty and who still have their ovaries, oocytes (egg cells) can be cryopreserved for use at a later time. This process can take two or three weeks and requires a doctor to give the patient synthetic hormones which induce oocyte production.

Fertility preservation for people who were assigned male at birth
In patients who have at least begun puberty and who still have their testicles, sperm can be cryopreserved for use at a later time. The sperm can be collected manually or can be extracted by a doctor. The process only takes a day.

Cost
Insurance companies generally consider fertility preservation as "not medically necessary", and thus do not cover these procedures, even when covering other transition-related healthcare.