Fertility Preservation

By Nick Peplow·Gender-affirming surgery coordinator

Last reviewed 12 October 2026· How this site is researched

Orchiectomy removes the testes. So does vaginoplasty, and vulvoplasty too. After any of them, your body can no longer make sperm, and that cannot be undone. If you might want a biological child one day, sperm has to be banked before surgery. Plenty of women think it through and decide it is not for them, and that is a perfectly good answer. What I want to avoid is the question coming up for the first time in a pre-op appointment, with a date already booked. I am a coordinator, not a doctor. This is information, not medical advice, and the plan for you comes from a fertility clinic and your prescriber.

What does and does not affect fertility

Only surgery that removes the testes ends sperm production. Facial feminization, breast augmentation, voice surgery and body contouring have no effect on it. Hormones are a separate question, covered below.

The options

• Sperm banking. The simplest and most common route. You produce a sample by masturbation at the clinic, or at home if you live close enough. It is checked, then frozen in small vials. Most clinics suggest several samples, a few days apart, to build a useful stock. Many trans women find this part emotionally hard. Clinics that see trans patients regularly understand that, and a good one will make it as easy as they can.
• Surgical sperm retrieval. If a sample is not possible, or contains no usable sperm, a urologist can sometimes take sperm or tissue directly from the testes under anaesthetic. This is usually called TESE. It costs more and is offered in fewer places. Some teams can arrange it at the same time as orchiectomy, but only if it is planned well before the day.
• Embryo freezing. Less common for trans women, but possible. Banked sperm is used with a partner's eggs and the embryos are frozen. In many places, including the UK, both people must consent to an embryo's later use, and either can withdraw. Banking your own sperm keeps the decision yours.

Oestrogen, anti-androgens and sperm

Hormone therapy reduces sperm production, and often stops it. Anti-androgens such as spironolactone or cyproterone, and GnRH blockers, suppress testosterone. Oestrogen suppresses it further. After months on hormones, many women have very low counts or none at all.

Sperm production can recover after hormones stop, but not for everyone. When it does, it often takes three to six months, sometimes longer. Specialists do not agree on how much time on hormones affects the odds. So the answer for you comes from a semen analysis, not from an average.

If you are already on hormones, the first step is usually a semen analysis while you carry on as normal. Sometimes there is still enough to bank. If not, a fertility doctor may suggest pausing hormones for a period to let production return.

The pause is hard, and worth planning. Coming off oestrogen and anti-androgens can bring back body hair growth, erections, skin changes and a real drop in mood. For some women it also brings dysphoria that feels like going backwards. Never stop or change your hormones on your own. Plan the pause with your prescriber, agree how long it lasts, and agree how you restart. Tell the people close to you before it starts. Some women decide the pause is not for them, and that is a valid choice. Others go straight to surgical retrieval instead.

Once frozen, your sperm is unaffected by anything that happens next. You can restart hormones as soon as the clinic and prescriber agree.

If you are not on hormones yet

This is the easiest time. Banking before your first dose avoids the pause question entirely. It usually adds only a few weeks to starting hormones. It is not a requirement for hormones or for surgery. If fertility matters to you, raise it at your first hormone appointment. Hormone requirements covers how hormones fit into surgical eligibility.

What banking buys you

Banked sperm gives you a real chance at a biological child, not a guarantee. Not every sample freezes well, and not every vial leads to a pregnancy. How the sperm is used later depends on the count and quality. Options range from insemination to IVF, where a single sperm can be injected into an egg. Using it also needs a partner's eggs and uterus, or a donor and surrogate. Surrogacy law varies widely by country and, in the US, by state. A fertility clinic can explain what your stored samples are realistically suited to.

Timing

Banking has to happen before orchiectomy or vaginoplasty. A realistic sequence:

1. Referral and a first fertility clinic appointment, with blood tests and a semen analysis: weeks privately, often longer through a public system
2. A hormone pause, if needed: typically three to six months, sometimes more
3. Several samples over a few weeks, or a planned surgical retrieval
4. Back on hormones when told
5. Surgery, with the usual pre-op hormone plan from your surgeon

If you are not on hormones, allow one to two months. If a pause is needed, allow six months or more. If you already have a date, tell your surgeon and the fertility clinic now. In my experience surgeons in Bangkok and elsewhere are happy to plan around this when asked early.

Cost

These are 2026 ranges, and they vary by clinic and city.

• US: initial banking is typically around $1,000 to $2,500, including tests and several samples. Surgical retrieval costs considerably more, often several thousand dollars.
• UK private: often £500 to £1,500 to bank, with surgical retrieval costing more.
• Storage: billed yearly, typically a few hundred in any currency, for as long as samples are kept. In the UK, the law allows storage for up to 55 years, with consent renewed every ten.

On funding: the NHS can fund sperm banking before gender-affirming treatment, depending on where you live, though waits can be long. In the US, some states require some plans to cover preservation before treatment likely to cause infertility. Whether gender-affirming care counts depends on the state and the plan. Read the policy wording, not the summary. See insurance.

Ask for an itemised quote that shows tests, each sample, any retrieval and the first year's storage separately.

Questions for a fertility clinic

• How many trans women have you worked with?
• Should I have a semen analysis before changing anything with my hormones?
• If a pause is needed, how long would you suggest, and how will you check progress?
• How many samples or vials would you recommend banking?
• Is surgical retrieval an option, and can it be done with my orchiectomy?
• What does the quote include, and what happens if I stop paying storage?

Bring it up at your surgical consultation too, so your surgery date is planned around it. With a little planning, you can keep this door open and still move forward with the surgery you want.