Gender diverse is an umbrella term used to describe people whose gender identity, including their gender expression, does not conform to what is perceived as the gender norm. This includes individuals who don’t identify within the male/female binary, those who identify with a different sex than the one assigned at birth (transgender), and more.
Research has shown that about 25–50% of transgender individuals are parents, with more wanting to start or grow their families. But lack of research, limited knowledge in the medical community, and discrimination in healthcare settings can all create barriers to family-forming for gender-diverse people.
Employers can support all employees’ goals by offering inclusive fertility and family-forming benefits that provide specific resources for gender-diverse, such as transgender and non-binary, employees. Below, we outline a few ways employers can ensure their fertility benefit includes all gender identities.
Improving access to gender-affirming care
Ensuring that your fertility benefit covers all gender identities is important. But employers can go beyond fertility care to support hormonal health and individuals seeking additional gender-diverse support.
Healthcare discrimination based on gender identity is common — in the U.S., 23% of trans people report being discriminated against in a healthcare setting. Lack of access to expert care is also a challenge; trans patients report that a lack of healthcare providers with expertise in transgender medicine is the largest barrier to access. Medical treatment specific to trans people is not taught in conventional medical curricula, and few physicians report a high level of comfort with providing trans-specific care.
In addition to discrimination in the clinical setting, individuals seeking gender-affirming care face insurance limitations. Only a small percentage of employer health plans include gender-affirming care, and coverage is often minimal. Individuals are subject to “proving” their identity and are only offered basic formularies for hormone medications.
To help, employers can provide employees with access to personalized care — whether that’s education, emotional support, chats with gender-affirming care experts, or even financial coverage for gender-affirming hormone therapy (GAHT). Employers can also support employees in accessing safe, specialized care. For example, Carrot’s network of clinics and agencies includes LGBTQ+ clinics and multidisciplinary trans health centers that can help members access the right care.
While most publicly available data focuses on access to care for transgender individuals, some people who do not identify as transgender still seek access to this critical area of healthcare. And while trans health is critically important and a valuable piece of Carrot’s overall support, others who are seeking this care may not identify with that term.
Supporting fertility options for gender-diverse employees
A lack of access to specialized care can also lead to gender-diverse people receiving harmful or inaccurate information about their fertility and family-forming options.
On Carrot’s Baby Steps podcast, trans activist Trystan Reese shared that when he transitioned, his doctors told him that he would not be able to get pregnant. But after doing some research and talking with other transgender men about their experiences, he stopped taking testosterone and was able to get pregnant, ultimately giving birth to a healthy baby.
“I hear often that medical providers are still telling people that if they go on testosterone, it will render them sterile, which is not true,” Trystan said.
In addition to improving access to specialized providers and gender-affirming care, employers can provide employees with trustworthy, accurate information to better understand their fertility and family-forming options. For example, Carrot has a digital library full of expert-produced educational content on gender-diverse fertility topics, including the impact of gender affirmation on fertility and fertility options for those taking hormones. Carrot members can also talk to Carrot Experts specializing in LGBTQ+ family-forming and gender-affirming care to get personalized guidance and their questions answered.
Getting knowledgeable and accurate information is an important first step for those on LGBTQ+ family-forming journeys. Carrot Expert Tasha Mansfield, RN, shares, “I always advise people to invest time in researching options ahead of time. Consult with your doctor or connect with support groups — learn as much as possible on the front end so that you’re as prepared as you can be.”
Fertility preservation and testing
More research is needed to more fully understand gender-diverse fertility. Research suggests that for trans men and transmasculine people, taking testosterone can potentially suppress ovulation — though it’s not contraception. It can also possibly alter ovarian tissue and should not be used when an individual is actively trying to get pregnant, according to reproductive medicine expert Amanda Adeleye, MD. For trans women and transfeminine people, estrogen and anti-androgens like finasteride can negatively impact the production and development of sperm, Dr. Adeleye said.
Because researchers don’t fully understand the long-term effects of GAHT on fertility, the best time to preserve fertility is before starting GAHT. If someone has not preserved their fertility before starting GAHT, however, that doesn’t mean they can’t have genetically related children.
“People who are trans-identified in some way feel like they can’t have a genetic family. That’s the biggest myth,” said Dr. Adeleye. “It does sometimes take extra work, but for many, as long as you have gametes [sperm or eggs] available, whether frozen ahead of time or if they’re still around, it’s possible to make that happen.”
Trans and gender-affirming healthcare providers can help patients determine their best options for fertility preservation and testing.
Inclusive language
Language matters when talking about fertility and family-forming. Many terms commonly used to discuss fertility, pregnancy, and family-forming aren’t inclusive of gender-diverse identities, so using inclusive language can be a powerful way to show support. The chart below provides a few common terms and more inclusive language options. You can find more guidance in our fertility language guide.
Creating a supportive work environment
Surveys show that gender-diverse employees are more likely to feel that their gender identity impacts how they’re perceived at work compared to their cisgender peers. For example, one in six respondents in the U.S. Transgender Survey reported being fired, denied a promotion, harassed, or attacked because of their gender identity or expression.
Creating an inclusive environment is critical to recruiting and retaining top talent. In fact, more than half of transgender and gender-nonconforming candidates and employees have dropped out of the recruiting process, declined a job offer, or left a company because of their perception of a non-inclusive work environment. Those who do work in a supportive environment and are open about their gender identity at work feel more authentic, professional, and innovative than those who are not out.
Providing fertility and family-forming benefits that meet the needs of gender-diverse employees is one way to help all employees feel seen and supported. Inclusive benefits like these can also include gender-affirming care support that provides financial coverage for GAHT, supports family-forming goals, and more.
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