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It's a really hard sell and it's very hard for young people [...] It's just not on their radar at all. Once you start on blocking agents and estrogen, it might end up being pretty different sperm." "It takes a lot of time and effort to work with your family and your loved ones, to figure out what it means to have a partner, if that's relevant to someone with their affirmed gender," Obedin-Maliver says.

"Even without any of the hormones, those processes take time, and they take a lot of energy.

It's a Maslow's hierarchy of needs issue — if you're dealing with [needing to secure] safety, food, shelter, intentionally planning children may not be on the top of the list.

Age-related fertility is a reality, and that's a reality for every human being.

"If you're having the kind of sex that could potentially get you pregnant, you should think about an additional method [of birth control] that could prevent that." Just in case!

Advanced reproductive technology, like in-vitro fertilization, for instance, can be prohibitively expensive. "In my experience, the folks that I work with don't have infertility problems," Menkin says.

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"It can be really hard by the time they get in front of a clinician, or in front of me — they are so excited and so ready to start hormones and blocking agents, the last thing they want to hear from me is, why don't we put this off for two weeks so you can go [bank] sperm."And trans people are no different in that." It's not common, but it happens."You will not be the first guy to get pregnant not expecting it," Menkin says.She also suggests the World Professional Association for Transgender Health as another potential resource.Menkin says the Gay and Lesbian Medical Association offers a searchable database of providers, organized by location, for instance."The issue more often has to do with a lack of access to sperm, or a lack of access to uterus and eggs.