Detransitioner’s pregnancy raises questions about transgender fertility

Editor’s note: This story contains descriptions of human reproductive anatomy and processes.

Prisha Mosley believed her womanhood was a problem. Hurting from depression, anxiety, anorexia, and suicidal thoughts, she started identifying as a male after she was sexually assaulted at age 14. In 2015, when she was 16, doctors prescribed testosterone. At age 18, she underwent surgery to remove both of her healthy breasts.

Mosley doesn’t remember exactly when she stopped taking male hormones, but she gradually transitioned back to identifying as a woman after years of taking hormones didn’t resolve her mental health issues. The road back to womanhood has been bumpy. She still has a deeper voice and some physical features of a man, but as she revealed recently, she has the fertility of a woman.

Last month, Mosley announced on social media that she was pregnant with a healthy baby boy. She isn’t the first detransitioner to become pregnant or give birth, but such a pregnancy is rare. It’s also a sticking point for those who say cross-sex hormones taken by youth cause infertility. Mosley’s pregnancy and a recent birth announcement from Daisy Strongin, another detransitioner, seem to fly in the face of that argument.

Research remains scant about the fertility and reproductive health of people after they end medical attempts to alter their sex traits. But limited research shows that some women taking testosterone can still ovulate and eventually get pregnant.

“It hasn’t been studied all that well … and it certainly has not been studied to any degree that would allow a practicing OB-GYN to give any solid answers in terms of data,” said Dr. Jeff Barrows, an OB-GYN and senior vice president of bioethics and public policy for the Christian Medical and Dental Associations.

Mosley, who took testosterone for several years from age 16 and got pregnant at age 26, said she was caught off guard when her doctor spoke to her about it. “He asked me if I could possibly be pregnant, and I remember that I laughed,” she said in a YouTube video posted last week. “I laughed because I thought it was ridiculous and impossible.”

Experts I spoke with said they didn’t find her pregnancy all that surprising. Women who have already gone through puberty and take testosterone in their late teens—as Mosley did—face the least damage to their fertility. That’s because girls are born with all the eggs they will ever need. By the time a girl finishes puberty as an early teen, her maturation into a fertile adult woman is essentially complete. Testosterone may halt her menstrual cycle, but it likely won’t alter her eggs, which finish maturing during puberty.

Male fertility is considerably more fragile. Unlike eggs, sperm have a short shelf life, so men who’ve gone through puberty need to make fresh sperm to stay fertile. Taking feminizing hormones such as estrogen affects a man’s long-term ability to produce sperm.

When it comes to puberty-blocking drugs, all bets are off. Experts told me boys and girls stand a high risk of losing their fertility if doctors prescribe medication to pause a child’s development.

Jamie Reed, who served as a caseworker at the Washington University Transgender Center at St. Louis Children’s Hospital, told me in an email that boys who take puberty-blocking agents will not develop normally. “They do not go on to develop the pathways to produce sperm, testicles will not develop, [the] penis will not grow,” she wrote. Reed is the whistleblower whose first-hand account in The Free Press and subsequent testimony ultimately led to the closure of the transgender center in St. Louis.

Barrows at the Christian Medical and Dental Associations said that during puberty, a girl’s eggs go through a process of maturation, a step he says is critical to make the eggs fertilizable. A girl taking puberty blockers, however, will miss that step, likely jeopardizing her fertility. Barrows could not identify a single study in which patients retained their fertility after taking both puberty blockers and cross-sex hormones.

What makes all of this worse, Reed said, is that doctors and pediatric gender clinics like the one she used to work at do not have lengthy conversations about fertility with current or former patients.

“We provided absolutely no guidance regarding fertility for anyone who stopped treatments,” she wrote. “We would ask patients if they wanted to have biological children, and if they said that they did not, that was sometimes the extent of the conversation.”

Meanwhile, cross-sex hormones and other methods of changing physical sex traits continue to receive wide support from medical associations that say such interventions alleviate psychological distress and promote overall well-being. Just last month, the American Psychological Association adopted a policy in support of “evidence-based care for transgender, gender diverse and nonbinary children, adolescents and adults.” The resolution, which passed 153-9 with one abstention, calls for insurance providers to cover transgender interventions.

Mosley said that, at her last appointment, she could already see how her baby’s mannerisms mirror those of her boyfriend, the boy’s father. “[My boyfriend] was sitting right next to me, crossing his ankles and folding his hands. The baby was doing the exact same thing,” she said. “We were trying to measure his femurs but he kept crossing his little ankles, just like his dad.”

Mosley told me that her pregnancy after detransitioning has brought with it a flood of emotions, as well as doubts. She’s already scheduled for a C-section, and she admits she still doesn’t trust a doctor with a scalpel.

“I’m trying to reframe it. I am not removing a body part like my breasts, which are gone forever. I’m removing a baby,” she said. “It makes sense to operate on the body, in this case.”