When Cole Carman went to see an endocrinologist for the first time, he was 17 years old. It was a late morning in early February and he was nervous and excited about the testosterone shot he was going to get—the first step in his transition to become the man he'd always felt like. Five months earlier, the East Bay teenager had confided in his parents that his biological gender was making him miserable and he wanted to do something about it. After researching, the family decided that Cole, formerly known as Nicole, should start on hormone replacement therapy.
But before injecting male hormones into Cole's body, the endocrinologist handed him a pamphlet on egg freezing. She told him that she felt ethically compelled to let him know that this was an option, because the testosterone could potentially cause his ovaries to shut down and the egg production to stop. Unlike most teenagers, Cole already knew that he wanted to be a parent. He said he needed to think about it.
"He looked disappointed when he came out, but then he showed me the pamphlet and we started discussing and researching. He decided that he really wanted to have children someday that were at least half biologically his, so the plan was to get married and use the eggs to impregnate his wife," says Cole's mother, C.J. Carman. Three months later, in May 2015, Cole became the first known transgender teen in the country to have his eggs harvested and frozen.
Until a few years ago, egg freezing was offered mainly to women who were undergoing chemotherapy or radiation that could ruin their chances of becoming pregnant later in life. But by 2012, the technology had advanced enough that the American Society for Reproductive Medicine (ASRM) removed the 'experimental' label from the procedure. Over the past few years, more and more women have been putting their eggs on ice for non-medical reasons. Fertility clinics everywhere from San Francisco to Wayne, Pennsylvania, host 'Wine and Freeze' parties, and big businesses like Apple and Facebook now cover the procedure in their employee health plans.
But egg freezing isn't just a way for women to put motherhood on hold. A growing number of transgender men are also having their eggs stored as a way of preserving their genetic material before starting a medical transition. Cole Carman's doctor, Aimee Eyvazzadeh, a fertility specialist at San Ramon Regional Medical Center, who's known as the 'egg whisperer' of Silicon Valley, believes that egg freezing is becoming more common in the transgender community. After Cole's story became public, many transgender men reached out to her, asking about the procedure.
"In October 2015, I threw an egg-freezing party in Brooklyn, and a lot of transgender people were there. The experience showed me that they are not a small part of the population, and they do want families and they are interested in hearing about their options," Eyvazzadeh says.
Samuel Pang, medical director at IVF New England, a fertility center in Massachussetts, also sees increased awareness of egg freezing in the transgender community. But the number of transgender men who actually go through with the procedure before their transition is still extremely low, he says. "For a lot of them it's just not something that's in their priorities. The reason that they're going through transition is that they're having a lot of psychological distress from what we call gender dysphoria. So preserving fertility is often the last thing they want to think about," Pang explains.
For more than 20 years Pang has been helping couples in the LGBT community become parents. Five years ago he started providing fertility preservation services for transgender people. "There are a handful of transgender men who do think about it and do want to have genetically related children," he says. "And I think as the community is becoming more educated about the opportunity to freeze their eggs, more and more transgender men will want to do this."
Most insurance policies don't cover egg freezing, so unless you're working for Apple or Facebook, there's a good chance that putting your eggs on ice is going to be costly. Cole Carman's parents funded his procedure, which cost around $13,000, not including storage of the eggs, a service that costs them around $30 a month.
C.J. explains that going in, she knew that her son's procedure was going to be expensive, and she would do it again if she had to. But she worries that the high costs will cause problems for other transgender people who dream of having a family someday but can't afford it. "We were blessed that we were able to scrape the money together, but there are a lot of people out there that don't have the means to do it. And they might have trouble if they're on testosterone for very long and don't preserve their eggs," C.J. says.
The prospect of crushing credit-card debt is exactly what's keeping Blake Hallberg, a 24-year-old trans man from Denver, from walking into a fertility clinic tomorrow to get his eggs frozen. A year ago he came out as transgender to his friends and family, and he's been taking testosterone for more than a month. He knows that long-term use of male hormones can potentially make it difficult to successfully undergo the egg-freezing procedure, but studying and working part-time as a dog walker, he just can't cough up the thousands of dollars for the procedure.
"I think it starts at $4,000 to $6,000, and then there's an annual cost just to keep the eggs frozen every year," Hallberg says. "And then it's like, what if I don't have a partner to carry that egg someday in the future? Then I have to pay for a surrogate or all of those previous costs will have been worth nothing."
Having children has always been important to him. In various Facebook groups he's been reading about transgender men who have given birth before transitioning, but he couldn't bring himself to do that, as it would conflict with his identity as male. Carrying a child was never an option for him, not even in middle school, when his friends were talking about getting pregnant and having babies.
At the moment, Hallberg is considering asking his family for a loan. His mother still hasn't fully accepted his identity, but his father has been supportive and Blake hopes he would help out if needed. And, if he does go through with the procedure and have a baby, he hopes his mother would be happy for him. "Not everyone in the community cares about having biological children, and I don't know, it would just be nice to have a family someday. That's what I really want—to be able to have a family when I'm mature and ready," he says.
High costs are not the only obstacle transgender people run into in the egg-banking process. Because there's little medical research from a transgender perspective, and because most doctors lack training in trans issues, Cole and his parents had to rely on whatever information they were able to dig up from personal accounts on YouTube, Facebook, and Instagram. "There wasn't anything out there that we could find about transgender people freezing their eggs. So we had a lot of concerns," says C.J., who founded the Facebook group Coley's Mom a year ago.
When Hallberg came out as transgender, the shortage of information was a consistent theme, he remembers. "There really isn't that much coming from medical officials, and if there is, it's very scientifically written," he says. "A lot of studies are translated for the layperson by journalists, but I have to rely on word of mouth."
According to Eyvazzadeh, many transgender men are never told about the possibility of freezing eggs before they get their first testosterone shot. A lot of the transgender people she's counseled over the past two years had already been on testosterone for a while when they contacted her. And for some of them, the thought of replacing male hormones with female ones was just too overwhelming.
"The decision to go off testosterone is such a big, lifestyle-changing one that many individuals choose not to," she says. "So really, we have to do better at educating trans males about egg freezing before starting their medical transition. A lot of people aren't being told that it's potentially fertility-threatening."
Whenever Pang meets with new potential patients, he presents their egg-freezing options. He explains that he personally prefers if they freeze their eggs before starting on hormone therapy, as going off testosterone could be disruptive to their transition process. But for reasons that are unclear to him, most transgender men choose to proceed with hormone therapy.
"I think especially for the patients that are 16 or 17 years old, they're more focused on issues on transition than what's going to happen ten years from now when they're married and ready to have children," Pang says. Furthermore, the hormone treatment is a lot less expensive and more likely to be covered by insurance than the egg freezing procedure.
Another obstacle for transgender men is the fear of stigma—the kind that comes from within the medical community, from receptionists, doctors, and nurses. Though most trans people experience discrimination at some point, the healthcare system was the last place Cole and his family were expecting to face it. C.J. had to call three fertility clinics before she found a doctor willing to help Cole.
"When I explained what we were trying to do, they just said 'Well, we don't really do that,'" she recalls. "So I called another fertility doctor, a really big fertility place here in California, and they didn't want to do it either. They said that they did egg freezing, but not for transgender people. Like there would be some huge difference in the process, which there really isn't. And just by the tone of the voice, I could tell there was an issue there."
In Denver, Hallberg is still in the process of contacting the local fertility clinic. To an outsider, it might sound like a five-minute task, but saying the word transgender out loud to a stranger isn't as easy as it sounds. "I've spoken with them via email, and I've said that I'm transgender, but something within me is stopping me from calling and making an appointment and explaining everything," he explains. "I would have to go in. It's very nerve-wracking. But I'll probably call."
Eyvazzadeh agrees that some doctors discriminate against transgender people. She recently received a heartbreaking email from the mother of a young trans man who was interested in freezing his eggs. Eyvazzadeh had referred her to a fertility clinic in New York, because the head of the clinic had written an article about the importance of offering egg freezing. But the clinic told the woman they wouldn't take care of her son. Looking online, Eyvazzadeh had thought that the clinic would be trans-friendly, but the truth is that's not always the case. "I felt so sad for her. I think that's the hardest part—feeling discriminated against. And it wasn't subtle. It was very obvious that they wouldn't accept her son as a patient," she says.
Although he's never heard about discrimination from his own patients, Pang isn't surprised that some clinics are uncomfortable with treating transgender people. It's hard to say whether there is a medical reason for it or not. "One potential concern could be if having been on testosterone will have any effect on the process," he suggests. His solution is simply to tell his trans patients that they have to be willing to go off testosterone for awhile. As soon as their testosterone levels drop, they will start ovulating and menstruating; that's when he knows their ovaries are functioning again and ready for the procedure.
While Cole Carman and Blake Hallberg share the dream of raising a child with someone they love, 24-year-old Ivor Lomion from Pretoria, South Africa, is about to have his eggs frozen for a whole other reason. At the end of last year, he and his mother went to talk to a surgeon who had worked with a lot of transgender patients, and that's when they first heard about the possibility of freezing eggs. "What my mom took away from the talk was that I should really find some way of keeping my genetic material," Lomion says. "So I'm basically doing this because of my parents. I'm not even sure that I particularly want children, and if I do, it doesn't matter that much that they are my genetic offspring."
In February, Lomion stopped taking testosterone to prepare his ovaries for the procedure. He had only been on it for two months, so besides a slightly deeper voice, nothing had happened yet. But the thought of going off male hormones made him depressed. He felt like he was putting his life on hold. "I don't know how long it will take before I can go on testosterone after the procedure, but I want to get back as soon as possible," he says.
He made it clear from the beginning that he had no intention of paying the bill, as he was saving all of his money for top surgery. So his parents agreed to pay. Five months later and only a few weeks away from the procedure, Lomion still thinks the whole thing might just be a huge waste of money. Especially since he will have to get a surrogate if he actually wants to use his own eggs. His partner was assigned male at birth, so she won't be able to carry the child, and like Hallberg, he feels he could never do it himself.
"But my parents think that in case my sister can't have a child, or my friends can't have children, someone will be able to make use of my eggs," he says. "And I understand their point of view. When you're in your twenties, or even your early thirties, children are just not on your radar."
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