#For transgender people wanting a family, specialist advice and support is key

For anyone whose gender identity is not aligned with that recorded on their original birth certificate, the desire to bring a child into the world can be complicated. Thankfully, the medical community is addressing this growing population’s unique needs.

“There’s a shift in society which is already notably helpful,” said Joshua D. Safer, MD, executive director of the Mount Sinai Center for Transgender Medicine and Surgery (CTMS) and professor of medicine at the Icahn School of Medicine at Mount Sinai. “We used to see trans kids escaping from unsympathetic households — now parents are on visits with them, trying to make sure things are done correctly. There’s wisdom from parents from that support,” he said.

For Max Kristula-Green, 31, growing up in Tokyo until age 18 led to a shielded outlook on life.

“The LGBT population and education surrounding it was limited there,” says Kristula-Green, who was born female but identifies as male. “I wasn’t well-versed or aware of anything other than heterosexual relationships until later, attending college at Parsons School of Design in New York City.”

At 21, Kristula-Green came out as a lesbian, met Cade Russo-Young, then 34, a few years later, and they married four years ago. He’d previously seen a Time magazine piece on trans individuals, and Kristula-Green found he related to their stories.

“I felt more male than female and started to transition socially to a more male identity,” he said.

After meeting up with other trans masculine people at a LGBT center, Kristula-Green learned more about this space and the subject of hormone therapy inevitably arose.

“In 2018, I went to Planned Parenthood to talk about potential hormone treatments and going on testosterone,” he said. “I learned what changes are and are not reversible.”

At that time, “Cade and I decided we’d want to have a child. Since Cade can’t get pregnant, the other options were for me to get pregnant or another route,” said Kristula-Green. “I knew pregnancy would be a temporary thing and felt like I had enough faith in myself that I’d be OK doing it.”

So, with a supportive family on both sides, Kristula-Green decided to postpone hormone therapy and focus on having a child.

“I didn’t trust my body to go through the whole process of going on and off of testosterone. Biologically, this didn’t sit well with me,” said Kristula-Green.

Instead, he consulted with Dr. Zoe Rodriguez, MD, assistant professor OB-GYN, Icahn School of Medicine at Mount Sinai, who his wife learned of through a Facebook group. Kristula-Green was seen by a reproductive endocrinologist to begin the process of intrauterine insemination (IUI) with donor sperm.

“It didn’t work right away,” he said. “After the fifth try, I was put on the drug Letrozole [used to induce ovulation], and after the eighth try, it worked.”

Although the process is “quite invasive,” said Kristula-Green, “the fact that I don’t have bad memories of it says something about the doctor.”

According to Kristula-Green, “The process sucks. Take breaks as much as you can. It was hard. It’s helpful to talk about it with a few close friends. Let people into your process and fall back on them to support you.”

The clinic provided a comfortable atmosphere, which made all the difference, said Cade Russo-Young.

“The intake form gave the longest list of options for how to identify yourself,” she said. “I was very surprised. The doctor was incredibly supportive and this clinic had put in the work to do the best they could. I felt grateful and lucky.”

Still, the number of medical centers and facilities devoted exclusively to this community are small, said Dr. Safer.

“Having academic medical centers step up and provide expertise for their communities and primary care physicians is going to be necessary,” he said. “It’s not a fringe, rare thing. We can’t get by with the few centers that exist already.”

Luckily, Kristula-Green’s pregnancy was “uneventful” throughout, and last December, he gave birth to Sy, a baby girl, via cesarean section.

“People who have an ability to carry a baby in their body — it’s amazing,” he said, although he said he wouldn’t do it again.

“We don’t want another kid,” says Kristula-Green. “We’re done. I wouldn’t want to get pregnant again. I felt like I was muscling through it. I felt very confused about it. As a male carrying a baby, I didn’t know how to let both exist at the same time. I did a lot of Googling on trans male pregnancy stories, and the ones I found — those who were able to be male and carry — normalized it for me. I felt very strong and empowered.”

Kristula-Green has also decided to hold off from undergoing any gender affirming testosterone therapy.

“There are certain changes once you start hormone therapy that aren’t reversible, and I don’t know that I’d be OK with, such as hair loss. My hair is a strong identifier for me. If there was selective testosterone, I’d do that. I don’t feel a burning desire to undergo any surgical procedures, either. We’ll see what happens in the future,” he said.

Throughout the pregnancy, the team at Mount Sinai “was fantastic,” he said. “They looked at us as if we were the most boring couple in the world, which was refreshing,” he said.

“I’m very grateful,” he added. “I haven’t figured out how to give back, how I can be the most useful. I’m still figuring that out.”