SAN DIEGO — There are many medical challenges LGBTQ+ patients face especially for fertility care.
Surveys show on top of the high costs to build a family and navigating insurance, many have negative experiences with healthcare providers
But for trans patients, it’s even more difficult to build a family.
“When people find out that I carried my child, they're astonished,” said Andie Hosch.
He was just as surprised to give birth to a son who is now three years old.
“I remember the doctor asking me, ‘are you sure you don't want kids?’ And at 19, I wasn't thinking about kids, I mean, I was 19. I was in college, I was just trying to be who I am,” said Hosch.
He was more concerned about feeling comfortable in his own skin than being told by a doctor at his college health center that the risks of taking testosterone would make him infertile.
“It was more important for me at the time, that I was comfortable with the voice that I heard, that I was presenting how I envisioned myself, than it was for me to worry about what my future family plans would be,” said Hosch.
But four years later as a trans man, he legally changed his gender and name, Andie wanted to be a dad, but he said all those misconceptions and even his own transphobia flooded his thoughts.
“’You need to freeze your eggs before you start transitioning, that testosterone would change your chemistry of your reproductive organs, being pregnant and having a kid would make me less of a man,’” said Hosch.
After seeing other trans fathers carry children, he met with Dr. Gina Frugoni, an OBGYN at UCSD who treats trans patients. Andie said Frugoni was confident he could conceive a child.
“She just made it so comfortable for me to be in that space, that is traditionally a very feminine space,” said Hosch.
But to prepare his body for pregnancy, Andie would have to stop taking testosterone and he said the gender dysphoria resurfaced.
“My voice, it went up like an octave, but it didn't go back to where it was before testosterone,” said Hosch. “My chest grew a little bit and that was like really uncomfortable.”
Before he got pregnant, via at-home insemination with the baby's father, Andie had top surgery, and while some trans men do, Andie said he had no intention of chest feeding.
“My chest started producing a little bit of milk,” said Hosch. “Starting to leak and things like that was way outside of my comfort zone. That would have been a reason for me to not have had a kid, that one piece. But [I] got through it with some fantastic people that are in my corner,” said Hosch.
This is where doctors play a key role in advocating and treating trans patients for fertility.
Many LGBTQ+ patients face barriers when trying to build a family. But UC San Diego Health has been nationally recognized as a leader in providing LGBTQ+ healthcare equality.
“I think that there's growing recognition that in the trans population, so many individuals want to grow their families,” said H. Irene, Su, MD MSCE, Professor of Reproductive Endocrinology and Infertility Fellowship Director Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences
Su is not Hosch's OB/GYN but works with Dr. Frugoni at UC San Diego Health. Su said many of the trans patients she treats face physical, mental, and financial burdens.
In vitro fertilization, egg or sperm donation, and a surrogate or adoption can cost $200,000.
Those factors make it even more daunting for trans patients seeking insurance coverage for fertility treatments.
“Codes for these procedures like egg freezing, it's related to a female patient, not to a male patient. And so sometimes you have automatic denials of pre-authorization, because the gender identification is incongruent with those codes,” said Su.
Su said despite California being one of the first state's to pass a law mandating insurance companies to offer coverage for fertility preservation, the 2019 law doesn't cover IVF. Still, many of her LGBTQ+ patients are getting denied which is leaving them with a lack of care and pushing providers to be more aware.
“The work that has to be done isn't simply advocating for these laws. But understanding where you follow, that law through these multiple systems, understand where the barriers are, so we can maybe have better laws,” said Su.
Andie said he legally changed his name and gender to male six years prior to but insurance wouldn’t provide coverage unless he was considered a female.
“So in an effort just to make it as easy as possible, they changed it back to female, which, you know, I was over it at that point and didn't want to fight or figure out a way for them to go around the different codes,” said Hosch.
He said it became a bigger problem after he was pregnant when he went to get his driver’s license renewed.
“It popped out with an ‘F’ on my driver's license. And I was like, ‘no, no,’ I went through this whole process, I stood in front of a judge to get this all changed. And now I'm going through it all again, because I had to because of one little marker that didn't allow me to get the proper insurance,” said Hosch.
With the support of doctors, Andie said he was able to navigate many barriers but he still struggled knowing that his son would have two dads.
“Is he going to be resentful of me because he doesn't have a mom? I took him to Pride a couple years ago, and he took a Trans flag and was waving it and in that moment, like, 'he is proud of who I am,' just like I'm proud of who I am,” said Hosch.
That pride took some time to build but Andie said he would tell his 19-year-old self and other hopeful trans parents to never give up.
“It was one of those things that while it was happening, I was like, ‘oh my God, is this ever going to end?’ And then it did. And now I have a beautiful child, and like a very fulfilling life that I live as a man,” said Hosch.
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