A Way Out of Detransition Panic: Cover Fertility Preservation

We don’t reduce regret by limiting choices. We reduce regret by making sure people have options.

Last week I had dental surgery, and while I am extremely happy with the results, it took much more of both my time and my energy than I expected, so I was unable to publish a new piece. As a thank you to my subscribers, I have made Chapters Two and Three of The Fall Line — a ski novella about ambition, intimacy, and the kind of love you try not to name — free to read. If you missed Chapter One, you can find it here. I am grateful for each and every one of you. Thank you for being here!

The people trying to ban gender-affirming care say they’re protecting kids. But if that were true, they’d make it easier to preserve fertility—not harder.

One of the most persistent sources of fear—both for trans people and for the people who love them—has always been fertility. Transitioning might mean giving up the ability to have biological children. And that’s not a small thing.

In my twenties, before I transitioned, my feelings about being a parent were a lot less complex and informed than they are now, many years into living as myself. Still, I had long, hard conversations with my partner at the time about what we might want years down the line—even as I struggled to imagine a future in a body that felt so wrong. The idea of preserving fertility felt abstract, out of reach, and not nearly as urgent as surviving the day-to-day. But looking back, I wish I’d had more support, more clarity, and more options. I cannot imagine having that conversation as a dysphoric teenager. It would have felt impossible.

These fears are real. But they are not insurmountable.

What if, instead of turning fear into restriction, we turned it into support? What if every trans person had the option to preserve their fertility before beginning hormone therapy or undergoing surgery—and didn’t have to fight their insurance company to do it?

Right now, fertility preservation is technically possible. But in practice, it’s out of reach for many. Sperm banking costs hundreds of dollars up front, with annual fees that add up over time. Egg retrieval can cost thousands, and that’s before you even get to storage. These aren’t expenses most teenagers—or many adults—can cover on their own. Especially not when getting basic gender-affirming care covered is already a battle.

If a cisgender teenager facing cancer can freeze their eggs or sperm without question, why should a trans teenager be told their future doesn’t matter?

If the real concern is regret, the solution isn’t to make transition harder. It’s to make it safer. More supported. More flexible. Fertility preservation won’t be the right choice for everyone—but it should be a choice. A real one. Not just something you read about after it’s too late.

And here’s the thing: the vast majority of trans people do not regret transitioning. Over 97% of us stay the course. But the people who do express regret often mention fertility as part of that grief. We don’t reduce that grief by banning care. We reduce it by treating trans people like full human beings, capable of making decisions about their futures and deserving of support as they do.

Everyone makes choices they later question—about school, marriage, jobs, medical care. We don’t ban college because some people regret their degree. We don’t outlaw knee surgery because recovery was harder than expected. Regret isn’t a reason to restrict care. It’s a reason to expand support.

The right loves to paint transition as a one-way door. A trap. A mistake waiting to happen. But what they never offer—what they refuse to offer—is a policy that would actually help.

Insurance coverage for fertility preservation before transition is that policy.

It doesn’t impose ideology. It doesn’t assume a future. It simply makes space. It says: you are allowed to change. You are allowed to grow. And we trust you enough to support your options, not restrict them.

Trans people don’t need protection from ourselves. We need protection from lawmakers who continue to use our lives as talking points instead of meeting our needs. We need care. We need autonomy. And yes—we need policies that reflect the complicated reality of being alive and trans in a world that still isn’t built for us.

So if we’re going to talk about regret, let’s talk about how to reduce it. Let’s talk about how to build a system that holds us up instead of boxing us in.

Let’s cover fertility preservation. Let’s give people options. And let’s stop pretending that the only answer to fear is control.