Parenthood and trans people

“Can I have a family?” is a question many transgender people ask themselves, often with a mix of desire and trepidation. The short answer is: yes. Trans people can become parents, and many already are. The paths to get there are diverse — biological, legal, social — and each presents specific opportunities and obstacles, especially in the Italian context. This article explores all the options honestly, without hiding the legal difficulties that exist today in Italy, but also without forgetting that science is on the side of trans families.

Biological children: the options exist

Contrary to what many believe, gender transition does not necessarily preclude the possibility of having biological children. The options depend on the type of pathway undertaken and how early fertility planning takes place.

Fertility preservation

The preservation of gametes — oocytes, sperm, or gonadal tissue — before starting hormone therapy or undergoing surgical procedures is the most established strategy. The WPATH Standards of Care version 8 (2022) explicitly recommend that all healthcare professionals discuss fertility preservation options with transgender people before starting any gender-affirming treatment [7].

For trans women (assigned male at birth), sperm cryopreservation is a relatively simple, affordable procedure with high success rates. Ideally, it should be done before starting estrogen therapy, as estrogens can significantly reduce sperm production over time.

For trans men (assigned female at birth), options include cryopreservation of oocytes or ovarian tissue. These procedures are more invasive and costly, but offer a concrete possibility of future biological parenthood.

The real problem, documented by the scientific literature, is that fertility preservation is discussed too little and too late. According to a 2019 review (Cheng et al.), only about 12% of transgender patients receive adequate fertility counseling and just 5% proceed with gamete cryopreservation [6]. The reasons are multiple: high costs (often not covered by the healthcare system), perceived urgency of starting the transition, and sometimes insufficient awareness among professionals themselves.

Pregnancy in trans men

One of the least known aspects of trans parenthood concerns the possibility for trans men to carry a pregnancy. If a trans man has retained the uterus and ovaries, pregnancy is biologically possible.

The reference study on this topic is by Light, Obedin-Maliver, and colleagues, published in Obstetrics & Gynecology in 2014 [2]. The researchers interviewed 41 trans men who had experienced pregnancy after transition. Of these, 61% had previously taken testosterone, and 88% conceived using their own oocytes [2]. The study documented pregnancies successfully carried to term, while also highlighting specific challenges: isolation, lack of adequate informational resources, and widespread unpreparedness of healthcare staff in managing pregnancies in transmasculine patients.

An important point: testosterone must be discontinued before and during pregnancy, as it can interfere with fetal development. After delivery, resumption of hormone therapy is possible. Subsequent studies, including a review by Obedin-Maliver and Makadon (2016) published in Obstetric Medicine, confirmed that fertility can return after testosterone discontinuation, even after years of hormone therapy, although timing varies from person to person [11].

A qualitative 2016 study (MacDonald et al.) also explored the experience of breastfeeding (or “chestfeeding,” a term used by many trans men) after delivery [8]. Of 22 transmasculine participants, 16 chose to breastfeed for a period. The experience was described as complex: positive in terms of bonding with the newborn, but sometimes a source of gender dysphoria [8]. Healthcare professionals following these pregnancies must be aware of these dynamics to offer adequate support.

The impact of hormone therapy on fertility

Gender-affirming hormone therapy is not a method of contraception and does not guarantee permanent sterility. However, prolonged hormone use can reduce fertility in ways that are not entirely predictable. For trans women, long-term estrogen therapy can cause testicular atrophy and reduced spermatogenesis, effects that are sometimes reversible upon discontinuation of therapy, but not always. For trans men, testosterone suppresses ovulation, but fertility can return after discontinuation [11].

The key message is: discussing fertility preservation as early as possible is essential, regardless of whether the person desires children at that moment [7]. Desires change over time, and having options open is a concrete value.

Adoption in Italy: the legal framework

Adoption is one of the paths to parenthood, but in Italy the regulatory framework is restrictive and requires a clear understanding of what is possible and what is not.

Full (legitimizing) adoption

Law 184/1983 reserves full adoption — the kind that creates a complete legal parent-child relationship — to married couples of at least three years (or cohabiting for three years before marriage) [10]. The couple must be composed of persons of different sexes.

What does this mean for a trans person? After legal gender recognition under law 164/1982, a trans person is for all intents and purposes of the rectified gender. If they form a heterosexual couple (for example, a trans man married to a cisgender woman, or a trans woman married to a cisgender man), that couple can formally access full adoption, meeting the same requirements as any other married couple.

In practice, however, the path can be more complicated. The psychosocial evaluations and social service investigations that precede adoption involve a thorough examination of personal and family history. A parent’s transgender identity might emerge at this stage, and it cannot be excluded that it may influence, even unconsciously, the evaluations. There are no systematic Italian data on how many couples with a trans parent have successfully completed an adoption process.

Adoption in special cases (art. 44)

Article 44 of law 184/1983 provides for adoption in “special cases” that do not require the couple to be married [10]. This form of adoption is also accessible to single persons and does not create a full parent-child relationship (the child maintains legal ties with the family of origin). The cases covered include:

• Stepchild adoption (adoption of the spouse’s child)
• Adoption of an orphaned minor by a relative
• Adoption of a minor with a disability
• Adoption when a stable and lasting relationship with the minor exists

Stepchild adoption has been used in Italy, through judicial interpretation, also by same-sex couples to recognize the bond between a non-biological parent and the partner’s child. For trans people, this can represent a way to formalize the relationship with a partner’s children, even outside of marriage.

In March 2025, the Constitutional Court declared unconstitutional the absolute ban on single persons accessing international adoption, potentially opening new possibilities also for single trans people.

Assisted reproduction (ART)

Law 40/2004, which regulates ART in Italy, limits access to different-sex couples, married or cohabiting, with documented sterility or infertility problems [9]. Access is not provided for single persons or same-sex couples.

For a trans person who has completed legal gender recognition and is in a heterosexual couple (on paper), access to ART is theoretically possible. The couple will need to demonstrate a certified condition of sterility or infertility. In many cases, trans people who have undergone prolonged hormone therapies or surgical procedures do present infertility conditions that would justify access to ART.

However, the situation can become paradoxical. A couple consisting of a trans man (with legal gender recognition) and a cisgender woman is legally heterosexual and could access ART with sperm donation, like any heterosexual couple with a male infertility factor. Heterologous fertilization was legalized in Italy by Constitutional Court ruling 162/2014. Since 2024, ART has been included in the Essential Levels of Care (LEA), meaning it should be guaranteed by the National Health Service in all regions.

The question of surrogacy

Surrogacy is illegal in Italy since 2004 [9]. In November 2024, Parliament passed a law extending the ban to surrogacy carried out abroad by Italian citizens, making it a “universal crime.” The penalty can reach up to two years of imprisonment and a one-million-euro fine.

This law has a significant impact on trans people, particularly trans women who, lacking a uterus, cannot carry a pregnancy. Surrogacy represented, for some, the only possibility of having a biologically related child. The Italian ban is among the strictest in Europe and applies regardless of whether surrogacy in the foreign country is legal and regulated.

Co-parenting and other family forms

Beyond traditional biological and legal pathways, there are forms of parenthood that deserve attention.

Co-parenting provides that two or more people decide to raise a child together without necessarily being a romantic couple. This family form has always existed, but it is becoming more visible. For trans people, it can represent an option when traditional pathways are precluded or not desired.

Foster care is another possibility. In Italy, foster care is open to single persons as well and does not require marriage. While it does not create a permanent parent-child relationship, foster care allows one to welcome a minor in difficulty and build a significant bond. Some trans people have taken this path as a form of parenthood.

What science says about children of trans parents

One of the most used arguments against trans parenthood is the alleged concern for children’s well-being. Scientific research, however, tells a different story.

The Golombok et al. study (2021)

The first quantitative study specifically dedicated to parent-child relationship quality and children’s psychological adjustment in families with a trans parent was conducted by Golombok and colleagues, published in Parenting: Science and Practice [1]. The study examined 35 families with 37 trans parents and 25 children between 8 and 18 years of age.

The results were clear: parents and children showed good-quality relationships, and children displayed good psychological adjustment [1]. The child’s age at the time of communication of the parent’s gender identity was not correlated with outcomes. Adjustment problems, when present, were not correlated with the gender minority stress experienced by the parent. The study concluded that commonly expressed concerns about the negative effects of growing up with a trans parent find no support in the data [1].

White and Ettner (2007)

An earlier study by White and Ettner, published in European Child & Adolescent Psychiatry, examined 55 children of 27 trans parents, with a mean follow-up of six years from the parent’s transition [4]. Thirty-five percent of the children presented a psychiatric disorder, a rate comparable to that of the general population. Children who were younger at the time of the parent’s transition tended to have better relationships and fewer adjustment difficulties [4]. The most significant predictor of children’s distress was not the parent’s trans identity, but the level of conflict between the parents.

The Hafford-Letchfield systematic review (2019)

The most comprehensive systematic review on trans parenting was conducted by Hafford-Letchfield and colleagues in 2019 [5]. Analyzing 26 studies published between 1990 and 2017, the researchers identified recurring themes: how trans people negotiate relationships with children after disclosure and transition, the impact of transition on children, relationships with the extended family, and the role of professional support.

The review highlighted that parenting quality is not determined by the parent’s gender identity [5]. The factors that matter are the same ones that matter in all families: communication quality, emotional stability, educational consistency, and mutual support.

Biblarz and Stacey (2010)

Although more broadly focused on families with same-sex parents, the meta-analysis by Biblarz and Stacey, published in the Journal of Marriage and Family, provided an important contribution to the debate [3]. Analyzing the available evidence, the authors concluded that parents’ gender is not a determining factor for children’s development [3]. What matters is the quality of family relationships, not their composition.

Legal recognition of parenthood

In Italy, legal recognition of parenthood for trans people presents specific complexities.

When a trans person has children before legal gender recognition, the situation can generate bureaucratic inconsistencies. For example, a trans man who gave birth before recognition is listed as “mother” on the child’s documents, but after recognition legally becomes a man. This discrepancy can cause practical problems in school, healthcare, and administrative settings.

When a trans person has children after recognition, the situation is more straightforward on paper, but can still raise questions regarding parenthood recognition, especially if the couple is unmarried or if conception occurred through ART.

The topic of parenthood recognition for same-sex couples (and, indirectly, for couples with a trans person before recognition) is at the center of an evolving legal debate. Several Italian courts have recognized dual parenthood in specific cases, but uniform national legislation is lacking.

Challenges and discrimination

It would be dishonest not to talk about the real difficulties that trans families face.

In healthcare

Trans men’s pregnancies, as documented by Light et al. (2014), often clash with an unprepared healthcare system [2]. Medical staff may lack specific training to manage pregnancy in a transmasculine patient, with consequences ranging from the use of inadequate language to errors in clinical management. The lack of specific protocols is a concrete problem.

In social settings

Stigma toward trans families exists and can manifest in children’s school environment, in relationships with the extended family, and in everyday interactions with institutions and services. Children of trans parents may find themselves having to explain their family situation in settings that are not always welcoming.

In legal settings

The absence of comprehensive legislation on parenthood for trans and same-sex people creates legal uncertainty. Families depend on case law, which varies from court to court and from city to city, making rights essentially a geographic lottery.

Trans families already exist

Beyond data and laws, it is important to remember a simple fact: families with trans parents already exist. They exist in Italy and around the world. They are families where people grow, argue, laugh, and face everyday life just like all others.

Some trans people already had children before beginning their gender affirmation journey. Others chose to become parents during or after transition. Still others are building families through foster care, co-parenting, or simply by choosing to be significant parental figures in children’s and teenagers’ lives.

These families are not asking for privileges. They are asking for recognition, adequate legal protections, and the respect that any family unit built on love and responsibility deserves.

Practical resources

For trans people who wish to become parents or who already are, there are reference points to turn to.

Information and support

• Infotrans.it — The institutional portal of the Italian National Institute of Health dedicated to transgender people, with information on health pathways, rights, and services [12]. Website: infotrans.it
• Famiglie Arcobaleno — Association of LGBT+ parents with children, active throughout Italy. It offers peer support, legal information, and advocacy for family rights. Website: famigliearcobaleno.org
• Agedo — Association of parents, relatives, and friends of LGBT+ people, with 33 branches in Italy. Website: agedonazionale.org

Legal support

• Rete Lenford (Advocacy for LGBTI+ Rights) — Network of lawyers specializing in the rights of LGBTI+ people, including issues related to parenthood and filiation recognition. Website: retelenford.it

Fertility counseling

• ONIG (National Observatory on Gender Identity) centers follow WPATH standards and can direct toward reproductive medicine facilities with experience in treating transgender patients [7]. Website: onig.it
• ART centers across Italy can be consulted through the National ART Registry of the Italian National Institute of Health.

A right, not a concession

The desire to have a family is universal and does not depend on gender identity. Scientific research — from Golombok [1] to White and Ettner [4], from Light [2] to Hafford-Letchfield [5] — converges on one point: children of trans parents do well when they grow up in loving and supportive families, just like all other children. The quality of the parent-child relationship matters infinitely more than the family’s configuration [3].

Italy still has a long way to go legislatively. Adoption and ART laws were designed in a different era and do not account for the reality of trans families. Case law is slowly filling some gaps, but regulatory uncertainty remains a concrete burden on these families’ lives.

In the meantime, trans people who wish to become parents deserve to know that options exist, that science is on their side, and that they are not alone. Planning, getting informed, preserving reproductive options as early as possible [7], and seeking competent legal and psychological support are concrete steps that can make a difference.

Every family has its own story. Trans families are no exception. And every child deserves to grow up knowing that their family is valid, recognized, and protected by law — a goal toward which we must continue to work.