Family-building options for LGBTQ+ couples are more accessible and empowering than ever before. Whether you’re a single man, part of a same-sex male couple, or a transgender man looking to preserve fertility, understanding male fertility testing is a crucial first step in your journey toward parenthood.
This guide outlines what men in LGBTQ+ relationships should know about fertility testing—including what to expect, how to prepare, and the options available based on your goals.
Why Fertility Testing Matters
Male fertility testing is not just for those facing infertility. For many LGBTQ+ individuals and couples, it serves to:
- Assess reproductive health before starting assisted reproduction
- Plan for sperm freezing prior to hormone therapy or gender-affirming surgeries
- Choose the best option for donor sperm use, surrogacy, or co-parenting
- Understand any underlying medical conditions affecting sperm health
Early testing offers clarity, flexibility, and more informed choices—especially when timelines, financial investment, and emotional preparation are involved.
Who Should Consider Testing?
You should consider male fertility testing if:
- You’re part of a cisgender male couple planning to use a gestational carrier
- You’re a transgender man wanting to preserve fertility before transition-related treatment
- You’re a nonbinary individual assigned male at birth (AMAB) exploring biological parenthood
- You’re considering sperm donation (to your partner, a friend, or through a clinic)
- You’re a single man interested in parenthood through surrogacy
Step-by-Step Fertility Testing for LGBTQ+ Individuals
Step 1: Choose an LGBTQ+-Friendly Fertility Clinic
Look for clinics that explicitly welcome LGBTQ+ patients and have experience with third-party reproduction (egg donors and gestational carriers). Staff should be familiar with your unique legal, emotional, and medical needs.
Step 2: Initial Consultation & Medical History
You’ll meet with a fertility specialist (often a reproductive urologist or reproductive endocrinologist) who will take a complete history, including:
- Hormonal issues, prior surgeries, STIs
- Past use of testosterone or hormone therapy
- Lifestyle factors (smoking, alcohol, etc.)
- Sexual and reproductive goals (e.g., surrogacy vs. co-parenting)
For transgender individuals, discussions may include previous or planned hormone use, timing for fertility preservation, and effects of estrogen or testosterone on gamete health.
Step 3: Semen Analysis
A semen analysis is the most important diagnostic tool for evaluating male fertility. It assesses:
| Parameter | Normal Range (WHO, 2021) |
|---|---|
| Volume | ≥ 1.4 mL |
| Sperm concentration | ≥ 16 million/mL |
| Total motility | ≥ 42% |
| Morphology | ≥ 4% normal (Kruger strict criteria) |
| Total sperm count | ≥ 39 million per ejaculate |
If results are abnormal, a repeat analysis is done after 2–3 weeks to confirm.
Transgender men who have been on testosterone may show reduced or absent sperm production. Discontinuing testosterone for several months can sometimes allow spermatogenesis to resume.
Step 4: Hormonal Testing
Hormonal blood tests help determine the cause of sperm abnormalities or verify the presence of viable sperm-producing function. Common tests include:
- FSH and LH: Stimulate sperm and testosterone production
- Total and Free Testosterone
- Estradiol: Elevated levels may suppress spermatogenesis
- Prolactin and TSH: Evaluate for pituitary or thyroid issues
These tests are especially important for those with a history of gender-affirming hormone therapy.
Step 5: Sperm Banking (Optional or Recommended)
Many LGBTQ+ men choose to bank sperm for future use, particularly if they:
- Are about to start testosterone therapy or have upcoming gender-affirming surgery
- Want to delay parenting but preserve fertility while they’re younger
- Want to protect sperm against potential medical conditions (e.g., cancer)
Sperm freezing is a relatively simple and low-risk process. Samples are stored in cryogenic tanks and can last for decades.
Step 6: Discuss Fertility Pathways
Once testing is complete, your clinic will help you explore your options, such as:
👶 Gestational Surrogacy
- Ideal for cisgender male couples or single men
- Requires a gestational carrier and often an egg donor
- Fertility testing determines which partner will provide sperm (or both)
🧬 Reciprocal IVF (Shared Fatherhood)
- Some couples choose to fertilize multiple eggs with sperm from both partners
- Embryos can be transferred to one gestational carrier
- Testing helps select the sperm source with better parameters if needed
🧊 Fertility Preservation
- For trans men, sperm banking before starting testosterone preserves future fertility
- Counseling should be offered before beginning hormone therapy
Legal and Ethical Considerations
LGBTQ+ individuals face unique legal considerations with parenthood:
- Parental rights, especially when using surrogates or donors
- Contracts with gestational carriers and sperm donors
- Navigating state laws for surrogacy and birth certificates
Work with clinics that provide or coordinate legal counsel experienced in LGBTQ+ family building.
Final Thoughts
Male fertility testing is an empowering first step for LGBTQ+ individuals and couples who want to build a family. Whether you’re exploring surrogacy, sperm donation, or fertility preservation, testing provides clarity, peace of mind, and a roadmap to informed, inclusive reproductive care.
Remember, family comes in many forms—and science, medicine, and compassion can help make yours a reality.
