Trans Men Need the Competent Fertility Care I Never Got

Alex Abramovich

For as long as I can remember, I have wanted children. For most of my life, I thought that I would carry my child, but those feelings changed shortly after I came out as a trans man and started taking testosterone. Producing a genetically related child was still important to me, but I was no longer able to see myself carrying a pregnancy. After discussing all of our options, my wife, Caroline, and I decided that the closest we would ever get to creating another human together would be to fertilize my eggs with donor sperm and to then implant the embryo into Caroline for her to carry the baby.

Unfortunately, fertility preservation, or what is more commonly referred to as “egg freezing,” was not presented to me as an option prior to starting testosterone. This meant that I would have to wean off of my masculinizing hormones so that my ovaries would be able to ovulate again. And that was just the beginning of a longer journey. Once ovulation began, I’d then undergo an in vitro fertilization hormone-injection process as well as a series of ultrasounds prior to the egg retrieval procedure.

Honestly, the thought of this terrified me, given how well I had responded to my hormone treatment — which had lowered my voice, allowed me to grow facial hair, and helped people finally see me as male. Starting testosterone was one of the best decisions I had ever made. I was at a point in my life where I felt comfortable in my own skin. Going off of testosterone made me worry about dealing with extreme body dysphoria — that discomfort over the mismatch between my physical sex and internal gender identity. For all of these reasons, it was incredibly important for us to find a fertility clinic that was trans-positive and competent with trans clients.

After doing our research, we selected a fertility clinic in a busy downtown Toronto hospital known for its trans-inclusive policies, which eased our stress and made us feel safe. Little did we know that this experience would quickly turn into a nightmare, due to trans incompetent and ignorant staff and physicians at the clinic.

As I went off of testosterone and prepared myself for the worst, I had no idea just how difficult this would all be. There were certain points that were harder to get through. By the three-week mark, I was an emotional mess. I felt intensely homesick for myself because my feelings had become so foreign to me. I started journaling my experience. Here is a short excerpt from three weeks off of testosterone:

No one warned me about these feelings. No one talks about this. There is no warning label for this type of emotional disaster. I feel empty. Isolated. Tired. Angry. Insufficient. Testosterone brought ease. It took the edge off. My chest is heavy. I don’t think it’s ever felt this heavy. I feel weak. Pushing and pulling myself. Sleep does not come easily and my dreams stress me out. I don’t recognize these feelings. Give myself back to me.

I wanted so badly to speak to another trans man who had gone through what I was experiencing — both the medical procedures and the emotions — but I was unable to find anyone. I finally found a couple of guys who had been through different fertility processes who agreed to speak with me, and I will forever be grateful to them. I don’t want any other trans men to feel as alone as I did, which is why I’m opening up about my story now.

I arrived at the fertility clinic for my first ultrasound three months after I went off testosterone. I was told to put on a hospital gown and sit in a waiting room with a group of women. They all looked genuinely excited. I truly wanted to be able to share their enthusiasm; after all, we were all there for the same reason — to start a family. But instead, I was made to feel like I did not belong. 

When the nurse on duty came out of the ultrasound room to call the next patient in, she glanced over at me and stopped. I’ll never forget the look of shock on her face. As she walked away, she turned her head to look back at me, not once, not twice, but three times, almost as though to make sure that what she was seeing was actually real. This, of course, caught the attention of the other patients, who now started staring at me as well. I tried to distract myself by locking my eyes on the ironic “trans inclusivity” poster on the wall in front of me, realizing with a sinking heart that the trans-competent care I had been led to expect was not going to materialize at all.

That week I filed my first of three complaints against the clinic. I described the degradation of being made a spectacle as I waited in a hospital gown with a group of women, and the way that the nurse on duty had treated me. I even explained how simple it would be to resolve these issues, such as directing me to the ultrasound room so that I could change and wait for the medical team. The nurse-practitioner on the other end of the phone line immediately promised that the second ultrasound would be much better and that there would be a plan of care in place. 

When I arrived at the clinic a month later for my second ultrasound, I was dismayed to find that there was no such plan in place. Instead, the physicians and nurses discussed the details of my health care in front of a group of female patients. The nurse on duty then referred to me as “she” and never apologized when my partner corrected her: “He, you mean he.” It was humiliating. I felt so crushed.

One week later, I began injecting myself with $10,000 worth of IVF hormone medication. Granted, the ordeal would be difficult for anyone. But having gone years without my body exposed to “female” hormones, I had a particularly grueling time adjusting to the side effects. There were radical emotional shifts, going from not being able to cry for close to three years, due to testosterone, to suddenly crying at the slightest emotional wave, and intense physical shifts, such as losing some of my much-loved facial hair. Even though my overall appearance did not change dramatically, it felt to me like it did, which seriously affected my confidence.

But as excruciating as all this was, what continued to be the most difficult thing to deal with was the fertility clinic’s treatment. Caroline and I felt shocked every time we had an appointment. During one, the physician couldn't even bear to look at me, so she stared at the wall. Much of it was unspoken like that — a feeling conveyed through tone and body language that there was something wrong with me. Every time I walked into a room, the mood completely changed. The staff’s discomfort with me was so obvious that it made every conversation and interaction painfully awkward. It was like they had no idea how to simply treat me like a human being.

During my final ultrasound appointment, the nurse assigned to me was the same one who had already referred to me as “she” and had supposedly been spoken to by management — which was hard to believe. When I entered the exam room, she once again referred to me as “she.” Luckily, the medical director was there to immediately correct her. At the end of the ultrasound I asked if I could speak to the medical director in private, because I wanted to ensure that the nurse would not be present during my egg retrieval procedure.

“This is the third time that I have heard this nurse refer to me as ‘she,’ and it’s really hurtful and unacceptable,” I explained to the medical director.

“Yes, it’s unfortunate, especially given that she has already received training. Actually, all of our staff have received training,” she responded. “It just doesn't stick for some people.”

I was so upset that I cannot remember what I said after that. I couldn’t fathom how a nurse in one of Canada’s leading hospitals could so easily be let off the hook by a verbal shrug — “It just doesn’t stick.” My egg retrieval was in two days. I had run out of time and energy to continue pushing for  better treatment. And given how defensive the medical director was, I felt conscious of not wanting to upset her — which speaks volumes about the power imbalance that is inherently present between patients and physicians.    

The long-awaited day of my egg retrieval finally arrived. I was handed a stack of forms to sign. When my eyes reached the bottom of the page, I was only able to see two words: “female patient.” I looked at my nurse. “Why am I the ‘female patient’?” “We do have updated forms, but these are our old forms,” she replied. I had a long day ahead of me, so I just put my head down and signed.

Caroline and I headed to the exam room. The actual egg retrieval procedure was the most painful experience of my entire life, both physically and emotionally. My wife was so distraught at the excruciating pain that I was clearly in that she cried and yelled at the doctor to do anything to help me.

Finally, it was over.

What isn’t over is the psychological pain from my memories of being treated like a disease that one might catch, and my fear of this happening every time I see a new doctor. After months of false hope and empty promises that the clinic would do better, it is clear to me that the staff did not understand what patient-centered care looks like, let alone what it might look like for trans patients. They were only prepared to deal with one type of patient, and if you fall outside of that, you are made to feel like a burden. Over the years, I have dealt with my share of ignorant medical teams, yet every time it happens, it is absolutely astonishing.

Positive-space posters don’t make a space positive if the attitudes and beliefs don’t align. I am grateful that I was in a position where I was able to advocate for myself and file numerous complaints. I also provided the clinic staff with practical resources and recommendations to improve their care, so that they can become more in line with their trans-inclusive policies. It is my only hope that the staff learned from this experience so that no other couple has to go through what we went through.

In the end, although this experience was certainly traumatizing, we have no regrets. Caroline is pregnant, and we look forward to putting this behind us and starting our family.

DR. ALEX ABRAMOVICH is a researcher at the Centre for Addiction and Mental Health in Toronto. Alex has been addressing the issue of LGBTQ2S youth homelessness for the past 10 years. He is interested in youth culture, homelessness and health care, community engagement, and film-based methods. For more information, please visit ilona6.com.    

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