Table 5.

Barriers to FP

Cost
Cost prohibitive	“I was a 15-year-old who had to decide whether or not he wanted to be sterile his whole life. I did not want my parents to have to pay thousands of dollars for me to keep my eggs, so I made the decision at 15 to be sterile my whole life. So it was a big, like, effect on my mental health...”—16 yo “I cannot afford to like harvest eggs or stuff like that. Like that’s so expensive. Like I would if I could but there’s no way.”—23 yo “’… it’s expensive so then how would you pay for that mom? You do not have enough money to pay for egg storage and it gets expensive and then we’d have to pay for the harvest.’ And at the time, there was just no way.”—50 yo mother
Cost not prohibitive	“I think my family definitely could have helped out with it. I do not think it would have broken us financially, but I do imagine that for some other people yes, it could be.”—19 yo “Yeah. We discussed the cost. And a lot of things were very costly but thankfully we have really, really good insurance.”—16 yo “And we told him, again, do not worry about the cost if this is something you feel that strongly about, and actually his dad was very, really wanted him to do it. You know, so we told - because at first he was like it’s too expensive. We’re like take that out of the equation, you know, in your decision.”—53 yo mother
Storage	“Well, I had called a clinic and they said it was $300 to see if my sperm was even worth freezing. Then it was another $300 to do something else. Then it was $600 a year or $600 a month just to keep it frozen. I’m like, if I do not plan on having kids for at least 10 years, I do not really want to drop $60,000 on a child that I might not even want.”—20 yo “The money is a deterrent, because I’m not sure how much insurance would’ve covered. I have no idea. And then there’s the whole thing of storing them in somebody’s freezer.”—54 yo mother
Dysphoria
Pregnancy or birth	“Definitely not giving birth to any kids because, like, hella dysphoria. Other than my boobs, there are not a lot of things I get physically dysphoric about, but anytime even the concept of pregnancy comes up, it makes me physically nauseous.”—18 yo “I would not have like a kid coming out of me. No. No thanks.”—19 yo “He has no interest in bearing a child with his own body. That’s so traumatic to him he cannot even think about it. So we are fine. If he’s sterile, he’s fine.”—44 yo mother “And I think, you know, it’s hard if you are 13 years old, and you know the last thing you want to think about is having your body be pregnant or something like that. So, I think for him it was almost repellant.”—54 yo mother
Menstruation	“I just think of like the fact that she [physician] told me like I would have to stop taking T for a while and then wait for like - so then I would start my period again, so that would be like really uncomfortable.”—16 yo “Like they said that you’d be bleeding heavily like for I do not know how long. You’d have to take like estrogen, which is like the opposite of what I would be wanting to take and all of that.”—19 yo
Discordance between assigned and affirmed genders	“…mentally I feel like I would be the mother of the child and I do not want that. The entire time I’d just be, like, well, I’m the mom, I’m the mom, I’m the mom. It just mentally would not keep me sane. I’d be, like, but I’m the mom and I just do not like that. I want to be the dad.”—16 yo “As someone who felt so male, it feels like a slap in the face to be reminded of any possibility of pregnancy.”—19 yo “…you are trans and you do not want to remember that you were born female so -- but then they are going in there and doing something that’s very obviously because you were born female.”—19 yo
Stopping or delaying GAHs
Patient’s desire not to stop/delay GAHs	“My thoughts just came to, like, I want to start testosterone and I do not mind if I do not have to have my own kid.”—14 yo “Yeah, I was so eager to get on that I did not want to wait. I think it was maybe somewhere between one and three months more to, sort of, have that little process happen. No, I was really eager to start. So, yeah, I did not.”—19 yo “I mean, it’s a question of how long can I take to not transition yet.”—19 yo “I just think of like the fact that she told me like I would have to stop taking T for a while…”—16 yo
Parental understanding of youth’s desire to start/continue GAHs	“At that stage, anything that delayed his progress was, probably felt sort of unacceptable.”—54 yo mother “He was having an issue with I want to have kids but I do not want to stop the testosterone just to harvest eggs…”—50 yo mother