What happens to ovaries during female-to-male transition

Changes in the ovaries during gender transition taught us about androgens’ role in female fertility

This is, indeed, a very interesting question because the medical experience with females transitioning to males taught us a lot about the effects of male hormones (androgens) on ovaries. One of the very early stages of transitioning from female to male involves changing the hormone milieu from female to male. Females naturally have male hormones, just as males have female hormones but the concentrations vary. The level of male hormones in females is naturally much lower than in males. During transition, they, therefore, receive quite high levels of testosterone (the quintessential male hormone) to bring them to natural male levels.

And when the consequences were first observed, it was quite remarkable to learn that almost all women exposed to those very high testosterone levels developed ovaries with typical appearance of polycystic ovary syndrome (PCOS). This observation, indeed, clarified to some degree why women with PCOS demonstrated this typical appearance of their ovaries. Most PCOS patients have high androgen levels. These observations, however, also taught us that androgens play a very important role in how many follicles mature and how many eggs one will retrieve in an IVF cycle. Ultimately, these observations, therefore, contributed to our understanding of androgen effects on ovaries (like DHEA’s beneficial effects on fertility) and to androgen supplementation becoming a very common treatment in female infertility.

And here is, therefore, an important lesson for those who are either considering or are already in the beginning stages of transition: If, as many do, you wish to preserve your future ability to contribute your own genetic background to a future child by using your eggs in creating embryos, your transition period may be a very good opportunity to freeze eggs. The principal reason is that, once your ovaries become PCO-ish, you will produce a very large number of eggs for freezing. As discussed in the lead article of this VOICE, a good number of frozen eggs is required for a decent chance to have a child, either yourself or through surrogacy.

This is a part of the February 2019 CHR VOICE.

Norbert Gleicher, MD, leads CHR’s clinical and research efforts as Medical Director and Chief Scientist. A world-renowned reproductive endocrinologist, Dr. Gleicher has published hundreds of peer-reviewed papers and lectured globally while keeping an active clinical career focused on ovarian aging, immunological issues and other difficult cases of infertility.