The desire to have children is separate from your gender identity. Everyone in the Netherlands has the right to make their own choice about having children; we call this reproductive freedom. Hormone treatment affects your sperm production, which may reduce your fertility. If your testicles are removed, you will become permanently infertile. This means that you need to think about whether you might want to have children before you start hormone treatment and/or have genital surgery.

Thinking about parenthood can be difficult, especially when you are young. However, regardless of age, it is a good idea to discuss this with your healthcare provider and/or your loved ones. If you wish to have children or may wish to have them in the future, there are several ways to fulfil this wish. The options available also depend on the fertility of your partner, if you have one. Below, we discuss a few options.

If you wish to retain the option of conceiving a child with your own sperm cells in the future, you can freeze them. To freeze sperm cells, ejaculation through masturbation is required. For some, this can be an unpleasant experience that triggers feelings of gender dysphoria. In some cases, it is possible to extract sperm from the testicle surgically using TESE (Testicular Sperm Extraction). It is recommended that you have your sperm cells frozen before starting hormone treatment.

If you have already started hormone treatment, a fertility specialist can discuss the option of temporarily stopping your hormone therapy to be able to freeze sperm cells. However, this is a challenging process and the outcome is less certain than freezing sperm cells before starting hormone treatment. It is important to have your sperm cells frozen before genital surgery, as the testicles will be removed during the procedure. The removal of the testicles will render you permanently infertile.

To maximise the chances of having viable sperm cells, it is best to freeze them before hormone treatment begins. This is because sperm production decreases during hormone treatment, and this decrease may be permanent. Hormone treatment can also have negative effects on sperm cell quality. There are many factors that influence whether fertilisation and/or pregnancy is successful – this does not depend solely on the frozen sperm cells.

If you have not had any sperm cells frozen prior to starting hormone treatment, you will need to stop the treatment for at least three months if you wish to freeze sperm. Sperm production usually returns after three months, but this is not guaranteed. It may also take considerably longer than three months – sometimes even years. It is important to realise that beard growth and body hair may increase again once you stop taking the hormones. Furthermore, there is a high probability that your voice will deepen if you started taking hormone blockers early in puberty. This may lead to distress. Temporarily stopping hormone treatment may also delay the process leading up to genital surgery.

Amsterdam UMC provides further information here about freezing sperm cells. Sperm storage costs a maximum of €90 per year (2026). The price is set annually by the NZa; the most recent prices can be found on their website. Costs may vary between healthcare providers. You are responsible for paying the costs of sperm storage yourself.

You cannot automatically access your frozen sperm. If, in the future, you wish to use your frozen sperm to achieve a pregnancy, you will need to attend a new consultation at the fertility clinic. During this consultation, they will assess, for example, whether you are sufficiently capable of caring for a child at that time. The welfare of the unborn child is the primary consideration during this consultation.

Some people choose to fulfil their desire to have a child through adoption. For up-to-date information on adoption in the Netherlands, visit the FIOM Foundation. In May 2024, the Dutch government decided that adopting a child from abroad is no longer permitted. However, adoption procedures started before May 2024 will continue for the time being. For more information on rainbow parenthood and adoption within The Netherlands, please visit the website of the Meer dan Gewenst Foundation. Foster care is also an option; for further information, please visit www.pleegzorg.nl.