For those who are not transsexual, the answer is generally yes. But for those in the part of the transgender population who feel the need to bring their anatomy in line with their deeply held belief of being the opposite gender, this is a challenging question that's increasingly important.
Heightened awareness to and sensitivity toward all transgender people is resulting in younger and younger gender transitions. And the desire of younger transsexual people to become parents can be just as strong as for those who are not transsexual. But it presents a fairly significant challenge.
For a transsexual woman (assigned male at birth), genital surgery generally gives her a functional vagina constructed from her prior genitalia. It does not, however, give her ovaries, a uterus or a cervix. Medical science is far from being able to transplant those female reproductive organs for anyone, trans or not.
For a transsexual man (assigned female at birth), genital surgery generally gives him male genetalia that can sometimes be used for sex. It does not, however, give him functional testicles, and doctors are far from perfecting transplants for them, too.
These considerations are often missed by policymakers who set genital reconstructive surgery as a requirement for changing the gender marker on an identity document. GRS generally removes the ability to reproduce via conventional intercourse, and its exclusion of GRS from most employer health insurance coverage renders it unaffordable for many.
Much as non-transgender people who cannot conceive are resorting to creative means to bring a much-desired child into the world, so are transsexual people. For my information on this, I am relying on one of the best resources available for parents of transgender children, "The Transgender Child: A Handbook for Families and Professionals" by Stephanie A. Brill and Rachel Pepper.
For those needing to transition now but wanting to preserve the option of having biological children, both sperm and eggs can be banked for later use. When it later comes time to have children, one can choose to do so through assisted reproduction services with their female partner, or through engaging the services of a traditional or gestational surrogate. These are approaches also used by non-trans people.
Some transsexual men may still have female reproductive organs, either because they were unable to afford the cost of their removal, or because they may have chosen to maintain them "to keep their options open."
Yet bearing a child after being on testosterone therapy is not without risk. One is generally able to conceive and carry children about 18 months after stopping testosterone therapy, although there is no guarantee that the reproductive system will still function correctly. Trans men on testosterone treatments often have an elevated risk of developing polycystic ovary syndrome (PCOS), which usually causes infertility. There are also increased risks of birth defects after lengthy testosterone therapy.
A more pragmatic problem with this approach is that testosterone therapy will have already caused facial hair growth and lowered the voice, effects that are not reversible. You will thus appear to be a "pregnant man," the label given to Thomas Beattie when he received worldwide attention for carrying his child. The other trans men who have taken this route to have their own children have been more secretive in doing so.
Transsexual women, on the other hand, may still have male reproductive organs, either because surgery was unaffordable or to preserve reproductive options. For those desiring children, stopping estrogen therapy for a period of time may allow sperm production to resume, although it may not be at a sufficient level to produce a pregnancy without assisted reproduction, if at all.
The pragmatic challenge in this case will be that, without estrogen, facial hair may resume growing and breasts will shrink a bit, two things that are difficult for any woman to accept. For that matter, so will be going to sperm bank as a woman to store, rather than obtain, sperm.
Now, consider the additional challenges facing parents of transgender children. A child may be devastated when puberty arrives, bringing with it the prospect of a low voice and male facial features for those who believe themselves to girls, and breasts, menstrual cycles, and short stature for those who feel they are boys. These "secondary sex characteristics" are the features most likely to cause others to fail to perceive the child as a member of their gender.
Parents may respond now by placing the child on medications to block puberty before later allowing the child to begin cross-hormone treatments. But without having gone through natal puberty, anatomical males will not produce sperm and anatomical females will not have eggs capable of maturing for fertilization. Yet since natal puberty can resume normally as long as the blocker is stopped by age 16, some parents will feel safe following this course.
The much harder decision comes if the child insists on having genital reconstruction surgery. Ignoring the fact that surgeons almost never perform GRS on a patient under age 18, GRS before natal puberty essentially eliminates the ability of a child to produce their own biological children. This is an agonizingly hard prospect for most parents to accept.
So while there will likely be increasing numbers of "out" transgender children in the coming years, those who base policies on anatomy will need to be prepared for the fact that most of these children will not yet have had genital surgery.
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As it turned out, I'm Intersexed, so had a low chance anyway. But with technical help, after many miscarriages, my son was born. I transitioned 3 years later due to changes in my body leading me to no longer pass as male. Unfortunately one of the first symptoms of the change was total sterility rather than infertility, before I had a chance to store anything.
It seems there is a lot of pressure for trans people to continue the gender binary by choosing to be either "all" female or "all" male via surgery. (Sorry for the word choice. Our American vocabulary options seem to be lacking on this topic.) Sadly, a trans person is only socially acceptable by mainstream culture if s/he passes, and the best way to pass is to avoid experiencing puberty in one's assigned gender, followed by surgery. So yes, parents and their trans children are faced with some very difficult and personal choices. We want our children to pass so they will be socially acceptable which, in turn, increases their opportunities, but they are awfully young to decide about future reproductive possibilities.
Policies that require gender affirmation surgery to change one’s gender marker reflect our cultural struggle with gender ambiguity. The topic leaves me wondering about the relevance of legally and publicly marking one’s gender in the first place. Maybe it’s time to do away with the practice and let go of the ridiculous and inaccurate binary once and for all.
(1) Fear of death -- every surgery, no matter how routine and slight the procedure, brings a risk of death, with major surgery bringing major risks. SRS is major surgery.
(2) Fear of knives cutting one's body.
(3) Fear of the medical system, with risk of Tea-Party Taliban doctors and nurses butchering you.
(4) Health conditions which require blood thinners like Warfarin or Coumadin. If the blood doesn't clot then you bleed to death during or after surgery. If you stop the blood thinners then you dies from blood clots. Either way you die.
(5) Diabetes type 2 (melitus) with a1C test results higher than 7.0. Death is much higher risk above a1C 7.0, yet few diabetics can keep their blood glucose levels low enough to pass below that.
(6) $20,000 up front costs for genital reconstruction surgery for M2F, up to $100,000 for F2M.
(7) Fear of murder by nuts egged on by hate groups like Family Research Council, KKK, Tea Party, Neo-Nazis, or Koch-funded think tanks.
(8) Fear of murder by 20% hate-posters seen on HuffingtonPost.com.
These are a few of the compelling reasons that some transgenders hang onto what they started with.
Ally is a term that must be given to you. It is not something you can claim on your own. One way to earn that title is by labeling yourself as cissexual rather than ally.