“Kind of makes me wanna have kids, so I can do it right”: a qualitative study of transgender and gender diverse adolescents’ fertility counseling and planning experiences in Australia

Background: Clinical guidelines recommend that transgender and gender diverse (henceforth, “trans”) adolescents are offered fertility counseling prior to commencing gender-affirming medical treatment (GAMT) to support informed decision-making about future reproductive options. However, little is known about how trans young people experience fertility counseling or how these discussions shape fertility planning and parenthood aspirations. Aims: We aimed to explore Australian trans young people’s experiences of fertility counseling and planning, examine their perspectives on parenthood and reproduction, and identify implications for clinical practice and future standards of care. Methods: We conducted a qualitative study with trans young people receiving care at a tertiary pediatric gender service in Melbourne, Australia. Semi-structured interviews explored experiences of fertility counseling, fertility decision-making, and future parenthood aspirations. Data were analyzed using inductive thematic analysis. Thirteen participants ages 11–18 years took part in the study. Results: We identified four themes: (1) prioritization of medical gender affirmation, (2) gender dysphoria and fertility decision-making, (3) trusted sources of fertility information, and (4) parenthood aspirations and fertility planning. Participants valued fertility counseling as an important component of gender-affirming care, despite some reporting experiences of gender dysphoria associated with it. Participants described seeking information about their fertility outside of formal fertility counseling sessions and expressed interest in other pathways to parenthood. Conclusions: Fertility counseling should extend beyond discussions of gamete cryopreservation and include realistic discussions of broader family formation pathways to support informed fertility decision-making. Findings highlight opportunities to strengthen fertility counseling resources, support gender affirming fertility care practices, and promote informed fertility decision-making.