By Vivian Coday

Over the last few months I’ve been noticing pregnant women more often.  When I see a woman with a baby, I imagine the nine months she spent with a child in her belly.  Inevitably, surges of aspiration erupt.  Not necessarily because I want a child, but because I want the ability to be pregnant.  As a transgender female, my hormones mock me with the ghost of a missing womb and a freshly awakened biological clock. This unexpected feeling and emotional state have prompted me to put into perspective the realities of my situation.

Transgender females currently have very few options available to them if they choose to have a child, all of them based around sperm.  After medically transitioning through the use of hormone replacement therapy or HRT, fertility is all but entirely gone.  There is sometimes a chance to bring sperm production back if HRT is stopped, but this will also restore all the other effects of testosterone many transgender women want nothing to do with.  Body and facial hair will grow back and thicken, breasts will shrink, mental effects like anxiety, irritable temper, and depression, will return.  For me, nothing would be worth going through this process.

Gender confirmation surgery, or GCS, can help align one’s body to their mind and alleviate some dysphoria.  Genitalia are reconfigured to create a vaginal canal and labia.  Many glands are maintained that are homologous or similar to those found in the opposite sex.  There is no way to create a uterus or ovaries however, and the process removes the testicles and the possibility for sperm creation.

The cocktail of pills involved with HRT can cause side effects other than the intended realignment of hormones in the body.  The drug used to block testosterone can cause leg cramps, increased urination, and hyperkalemia.  Hyperkalemia occurs when there is too much potassium in the body leading to arrhythmia and possibly a heart attack.  The leg cramps alone have me considering removing the reason for taking these pills – my testicles and with them my fertility.

There are options.  Before transitioning some people assigned male at birth, or AMAB, may opt to put their sperm into a long-term storage facility, a sperm bank.  This can be expensive and price many people out, especially if they aren’t sure they even want to pursue having a child.  At the time of writing, Midwest Sperm Bank lists the price of long-term sperm storage at $300 a year.  I chose not to take this route, not only because of the price and hassle but because at the time,I had never had an opinion about having a child.  If it happened, I would gladly accept the role of a parent, but if it didn’t, I wouldn’t be concerned.

As I look to my future, I am left to consider my role and how I fit in it.  I have moved from a lackadaisical fertility to anxious sterility.  I have witnessed infertility weigh upon the psyche of friends.  As an outsider, it is heartbreaking to know how earnestly they yearn for a child only to find themselves unrequited.  Research has shown that nearly 30% of couples suffering from repeated failed attempts to conceive end up separating.

The biological impetus of life is procreation.  Typically, our bodies are equipped with hormones, cells, and functions that facilitate this.  When those instruments are disrupted, it can cause mental turmoil.  Frustration and depression are states that can create their own accumulation.  Over time this can be unbearable and give rise to the feeling that the relationship is no longer tenable.  Without procreation, terminally, our body becomes insignificant.  This illustration is harsh, but it can sometimes be how an infertile individual can subconsciously or even consciously be viewed.

Transgender women, by their very nature, are infertile.  We are often seen simply as objects to be fetishized over.  I have pondered how much our inability to propagate contributes to this.  Part of the attraction process for a long-term heteronormative relationship is the possibility at procreation.  When that is removed the only remaining aspects are aesthetic in nature.  In fact, much of the allure is based on our ‘exoticism’.  The thrill of the taboo and the desire for things a cisgender woman cannot provide.  These extrinsic inducements are too removed once GCS is obtained; we simply become infertile women.

If I were to wake up in my ideal world, I would have a functioning uterus and ovaries, gladly accepting all the other things that come with them.  I would not be someone’s fetish.  Being born with male genitalia would have just been a bad dream.  If this were the case, I feel the chances of me actually desiring and possibly having a child earlier in life would be significantly greater.  I never imagined my inner core and essence waking to the innervation of desiring pregnancy or even wanting a child.

It would seem all I can do is fantasize about a future where being born with the wrong genitalia isn’t a big deal.  Medically, science is just beginning to explore the reproductive possibilities available to transgender women without dependency on surrogates and male-oriented sperm.

Science fiction is often a soothsayer for the future.  Before and during my transition I have lived vicariously through literature.  Books that play with the idea of body altering have unsurprisingly been favorite reads for me lately.  Concepts like body swapping in The Identity Matrix by Jack L. Chalker are exciting but scientifically distant if not completely unrealistic.  Other novels such as John Varley’s Steel Beach present what could someday be closer to our future.

When the main character in Steel Beach, Hildy, decides to have a sex change, they go to a Change shop.  In Varley’s world, technology has reached such levels that having GCS is like getting a tattoo.  All that is required is an injection of a saline solution filled with programmed nanobots.

In 1993 when Steel Beach was published this probably sounded very implausible.  Today, in just 25 years, things like CRISPR or ‘clustered regularly interspaced short palindromic repeats’ can use our own biology to shape our reality.  It is a relatively new and complicated technology being researched in hopes of helping to solve congenital problems and cancer.  It works by modifying genetic code within individual cells.  Quintessentially genetic engineering, CRISPR faces an uphill battle not just in research, but societal and ethical acceptance.

Another way our genes can be used to help us can be found in stem cell research.  More accepted now than in the past, this research has allowed scientists to grow organs from scratch.  Because the patient’s own cells are used, the use of immunosuppressants would not be needed.  This opens the possibility for replacing damaged or lost parts of our body in the future.  The technology has already been used to replace tracheas, bladders, urethras, and vaginas.  Since this technology doesn’t modify genetic code, it doesn’t have the stigma associated with it as CRISPR does.

In December of 2017, a woman successfully delivered a baby after having a uterine transplant in Dallas.  Not only does this offer hope for women who have various types of infertility issues but also those not born with a uterus.

In the 1930s, there was an attempt at one of the first uterine transplants.  Lili Elbe underwent the surgery in 1931, well before immunosuppressants and accessible antibiotics.  Many records were lost due to Nazi book burning, but she was an AMAB person who may also have been intersex.  She, like me, wanted to feel more complete and whole as a woman.  She dreamed of the possibility of being pregnant.  Unfortunately, her dream was left unfulfilled after her body rejected the transplant.  Her story is an inspiration and battle cry for others like myself.  Eighty-seven years later, there have been eight live births to cisgender women from uterine transplants in Sweden alone.

After many years fighting for recognition, some medical professionals are finding it ethical and just for transgender women to receive transplants as well.  They recognize the psychological effects of infertility affect a transgender woman just the same as a cisgender woman.  Despite this, there are still a number of obstacles to transgender female pregnancy.  No transplants have been carried out yet in transgender women.

Just as transgender rights are finally being recognized, hopes of an even further transition are being realized.  Perhaps the chance at a future that more closely resembles my inner drives isn’t fantasy after all.  With today’s development of once incomprehensible technologies, perhaps tomorrow’s children will be born fully realized.

So for now I will fill the emptiness of my missing womb with hope.  When I see a pregnant woman, I will imagine future transgender children finding acceptance, love, and charity from their fellow human beings.  I will imagine transgender children living without inordinate worry and anxiety.  I will imagine transgender children growing up to be able to have children of their own in the way their body and mind harmonize with.  Though I may not live to see the day, children born in the future likely will.


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