45 | Supporting Trans Pregnancy

Meet the Guests:

Trystan Reese has been working in the LGBTQ movement his entire adult life. He’s worked with the National LGBTQ Task Force, Immigration Equality, Camp Fire Columbia, and the Young Nonprofit Professionals Network. In 2017, he exploded into the national spotlight when he chose to have a biological child with his partner, Biff. The sudden spotlight cast on his family allowed them to tell their unique parenting story to millions of people around the globe. Trystan lives in Portland with his partner Biff and their three amazing kids, and they can collectively be found on Facebook as “Biff and I.”

Jesse Fluetsch works hard as a Dad, as a private tutor, and at the Utah Pride Center where Jesse runs a weekly playgroup called Families Like Ours. Over the past ten years Jesse has helped build and facilitate programs for LGBTQ+ adolescents, young kids and their families in his local community. Jesse and his husband Rick are the proud daddies of 10 month-old Naomi, whom Jesse gestated.

Additional Reading/Listening:

Episode Transcript

Emily: Are you a member of the Trans Community who is considering parenthood? Are you already a parent? Are you an ally who wants to support the community? Family equality believes that everyone deserves to grow and sustain their family. We recently released a new Family Building for the Trans Community Guide that inspired me to talk to two trans parents who have shared their pregnancy journeys in various ways and their paths to parenthood. So I'm very excited today to talk to Tristan Reese and Jesse Fluetsch. So to get us started then, we, you both talked a little bit about this in your bio's, but I would love to know more about who is in your family and how was it formed.

Jesse: Yeah, I'd love to. And thanks for inviting me to talk about my family. I love talking about my family and my cute little baby. My husband Rick and I met at the University of Utah Queer Student Union nine years ago. And we got married six years ago. We decided to have a baby. It's something we talked about before we got married. When I was younger, I didn't see myself ever wanting to get pregnant or have a biological child. But that changed. And about two years ago we started the process of getting off testosterone and trying to conceive. Our family is Daddy Jesse, Daddy Rick and baby Naomi.

Emily: Wonderful. And Tristan, who is in your family and how was it formed?

Trystan: Yeah, well who is in my family is me, and I am Daddy, and then my partner Biff, who is Dada, and then we have our big kids (that's what we call them) Haley and Riley. They are nine and 11. And then we have baby Leo and he's two. And how was it formed? Well, Biff and I became parents overnight to little Haley and Riley when they were just one and three, when Biff's sister found herself unable to care for them in the ways that they needed. So they came to stay with us for a little while and that little while turned into a long while, which turned into forever. And our illegal adoption of them became final in 2015 and Leo is biologically my child and Biff's child and I gestated and gave birth to him in 2017.

Emily: And why did you decide that pregnancy was a way that you wanted to grow your family and what for you went into making that decision?

Trystan: For us, adoption was extraordinarily difficult. I think any way that you become a parent has its own challenges. And I think becoming a parent really suddenly with no preparation and then having to go through many legal hurdles to secure adoption. It wasn't as straightforward as we'd signed up and we got a placement. It was just way more complicated than that. And so between the emergency guardianship, the legal guardianship, the termination of parental rights and the adoption, it was a lot. It was a lot for us to go through though. There were a lot of years when truly at any point these kids could have been taken away from us and put back in a really dangerous situation. All it would've taken was one homophobic social worker and that would've been it for us. And it's really scary when you're already a marginalized person. Giving over that much power and control to strangers is terrifying. And so I knew that I wanted to have a bigger family. I talked to my partner about it. He agreed. We wanted to have more kids and we wanted to have the experience of becoming parents, not in a time of crisis. And to be honest with you, not at the expense of somebody else having their family torn apart. I mean, that is an extremely difficult situation to be in for everyone involved. We were curious about what it would look like to do it on our own, um, or to DIY it, I guess. And I know of transgender men who've had babies and so it wasn't something that was new or different to me. And I'm a nerd. So I dug into the data and I looked at the research and I was like, oh yeah, science agrees. This is not an extraordinary or exceptional thing to do. Bodies are amazing. And this is totally something that people do and can do and have done and will continue to do. So we decided to do it.

Emily: And Jesse, why your particular path to parenthood? What went in for you to making that decision?

Jesse: Well, when I was a younger transgender person, when I was a teenager, I never saw myself having a biological child. And looking back on that, I realize now that that was about me being miserable and hating myself and not wanting to create someone who would be miserable and hate themselves. So it took me hormonally transitioning and socially transitioning and becoming happier and more mentally healthy before it's something that I could even see as a possibility. And while I was growing up and going through my transition, simultaneously there were trans men in the news who were pregnant and giving birth. And when I was hearing about this, it seemed strange to me at first and it wasn't something I could relate to having that desire. Frankly, it wasn't until my nephew was born and I saw my sister-in-law right after the birth holding him and the bond between them was beautiful. And I knew immediately that I wanted that.

Emily: Thank you both. What are some of the things then that you wish you had known before starting that journey?

Jesse: I think when I was younger, when I was first transitioning, everyone was told that testosterone would make them infertile. And that's not true. And I wish that the doctors had better information and that that information had been disseminated properly. I know people who have had unplanned pregnancies while on testosterone. And I wish that I had known how supportive people in my life would be. I was scared. I was scared that my family would judge me or think I was putting our baby at risk. They were shocked when they found out I was pregnant and that Rick and I were having a biological child, but they were very, very happy for us.

Trystan: The misinformation is really rough and it comes from a lot of different sides. There are many reasons why there's misinformation. I don't know that there has necessarily been a huge desire from the academic and medical and scientific community to really study trans fertility. I'm not blaming any one particular person, but it just hasn't been a top priority. Most people don't know this, but the use of hormones for transition purposes, that's an off label use. So those hormones are not created for transition purposes. They're created for cisgender non-transgender women who are going through menopause and need estrogen. They're created for non-transgender men who have low testosterone. They weren't even made for us. Luckily for us, there are amazing LGBTQ+ academics who've studied the longitudinal effects of hormones on our bodies. We know a lot of that, but that's not what it was made for and that's not what it was tested for. Our providers have made some assumptions based on other data that they have that just isn't true for us. And so it's hard to unlearn all of those things. I too was told that testosterone would make me infertile and I'd never be able to have a child, which I didn't care about at the time cause I just wanted to transition. But I think that information trickles out and then everyone just assumes that A) you can't have a baby and then B) you certainly wouldn't want to because that's the thing that women do. And if you're trans and you're supposed to hate your body, you're supposed to not want to do anything that would be in any way associated with femininity. So it's can be very confusing to people. But I think like Jesse, I have an extraordinary amount of privilege and had a lot of people who were supportive around me.

Trystan: One of the surprising things is in the like pregnancy and fertility world, a lot of the assumption is that it is the job of the person who's going to get pregnant to know all the things. And that's usually a woman. And then it is not the job of the person who is not getting pregnant to know literally anything. And that's usually the husband. And so I think a lot of the people in those worlds kind of assume that men are idiots. I mean, I was treated like an idiot a lot. Even after Leo was born, a lactation consultant, first of all, she came in and my partner was holding the baby instead of me. I was resting, I had just given birth and she was like, oh well, well is this a strange turn of events? Which was so weird. I guess normally it's the person who gives birth that's holding the baby and not the partner. It was so weird. And she was like, Oh, I'm worried about the sound that he's making when he's feeding. And I was like, Oh, do you think he might have a tongue tie? And she's like, you know what a tongue tie is? I was like, yeah, I read like 15 books on pregnancy and childbirth. I'm in like 12 Facebook groups. Yeah, I know what a tongue tie is. It was weird being treated like a man in a space where men are not usually engaged in the process. So it was very confusing to people in that realm. But once they saw like, yeah, we know what we're doing, we already have two kids and they have survived our parenting this long, so I think we'll be fine.

Emily: Yeah. Did you also experience some of those like expectations of what parenthood means for men and women and how people just perceive that being so radically different?

Jesse: I'd say I've experienced it more after the birth of Naomi. Every group I go into, every parenting group, every play group, I'm the only man. Not only am I the only queer person and the only trans person, but I'm the only dad. And by the way, these aren't called mom groups. They're called parent groups, but they're not. I think when people see me with my baby, they assume that I'm doing something some kind of special duty or something out of the ordinary when this is our everyday life.

Emily: Yeah, that's really interesting. And I can imagine frustratingly frequent in a lot of those interactions. You've both mentioned those early stages of transition and some of the information, especially about fertility that that doctors were sharing with you. Family Equality's Family Building for the Trans Community Guide starts by encouraging people to consider reproductive options and desires before starting any medical transition. Just now that there's more information too for folks to be considering. So Trystan, you mentioned this a little bit, but could you talk a little bit more about why becoming a biological parent really didn't factor into your transition and how did that maybe change over time.

Trystan: Yeah, I mean well there are two answers to that question. One is the personal answer and one is what the data shows. I'm going to start with what the data shows because that is 100% reflected in my experience. So there are several studies that are about fertility preservation and which is the medical process of preserving reproductive material prior to transitioning either trans masculine - if you're a transgender man or a non-binary person who was assigned female at birth - or trans feminine - a transgender woman or someone who's nonbinary who was assigned male at birth. So you can preserve your fertility before you transition for a variety of reasons. But just in case your fertility is going to be impacted by your transition. And in some cases it really is. What the data shows us is that the vast majority of transgender people do not preserve their fertility before transitioning. And there's a few reasons for that. For trans youth, by and large, they just say they don't ever want to be parents or they want to adopt. That is far and above the reason why they do not preserve their fertility. Not cost. And not that they don't want to postpone their transition - you do kind of have to pause your transition to go through a fertility process. That was not even in the top five. They were like, yeah, who wants to be a parent? Okay. Cause they're like 17 years old and when I was 20, 21, 22, first transitioning, hell no I couldn't think about ever becoming a parent. There's an overlap I think between what I was hearing from Jesse and similarly I just never thought about being transgender and being a parent. I didn't know anyone who was a transgender parent. I didn't know anyone who was transgender and married and had a family. I didn't know any trans people who were in healthy relationships period. So I was like, why would I even think about that? So when they said this'll cause sterility, I was like, no problem. Give me that beard juice. And I signed on the line and I didn't care. And I think that's a big part of what we see in the data - that a lot of trans youth aren't thinking about that.

Trystan: But it's really important to juxtapose that against what we see when we're in the research of trans adults. So about 78% of trans adults regret not preserving their fertility prior to transition. A majority of trans adults wish that they had preserved their fertility. And so for me, those are two really important pieces of information. Trans youth don't want to have kids, trans adults wish that they had the opportunity to have kids. And I think that that poses a huge and really important question to the trans community. How are we talking to trans young people about their possibilities for the future? How are we helping train providers on how to have these conversations in a way that respects their autonomy as full, whole, complete people, but also understands that developmentally, most young people aren't thinking about fertility and we want them to have those options, all the options available to them when and if they ever become ready. So, that's what keeps me up at night. Thinking about all the trans people that come to me at conferences, at workshops on the street and literally just start crying because they've transitioned to the point where they can't have biological kids. And until they heard my story, they had no idea that that was even possible. They didn't think they were gonna live long enough to have kids. They didn't think anyone was with ever going to love them, that they'd ever have a job. All the things that I didn't believe and now they actually have outlived those fears and they want to have the kind of life where they can share it with other people in a family as part of that and now they can't.

Emily: I love that like holistic look to caring for younger people now and that it isn't just a matter of medical information. It's also health, workplace protections, educational opportunities, housing, security. It is such a holistic thing for anybody to be deciding to become a parent, or feeling like they have the tools that they need and the resources and the security and safety that they need to be to be parenting in a healthy way. That's so universal. But it is especially important, uniquely important for the trans community. Jesse where did parenthood and thoughts of parenthood either biologically or adoption factor into your life?

Jesse: Well, first of all I really appreciate what Trystan was saying. The kids that I work with are 14 and under and some of them have already gone through their natal puberty, but others have put it on hold, and they would have to go through that puberty now in order to do fertility preservation. And none of them care. They do not see themselves having biological children. And this is with having seen me and me talking to them about my experience and bringing my baby to group. Unlike Trystan, I always wanted to be a parent. I just didn't want to have a biological child and it took me growing up and it took me transitioning and becoming happier and healthier and comfortable in my own skin for me to consider using my body to become a parent. The whole experience of carrying my baby and growing her inside my own body feels redemptive in that it's been difficult for me to be me to be a person with a male gender identity in this body. But in the end I'm glad I have this body because without it I wouldn't have Naomi and she's beautiful and I love being a dad.

Trystan: This is another perfect place to throw in some more numbers and data, which is that when you look at the experiences of trans identified people who've been through pregnancy, about a third share Jesse's experience about their own discomfort or dysphoria with their body actually lessening throughout the process of pregnancy and postpartum. And I know it sounds counterintuitive, but I'm so glad that you shared that. It's exactly what Jesse said, it's redemptive. Like here I have this body that I may have had complicated feelings about my whole life, but now it's doing something so good. It's doing something positive. It's creating life, it's nourishing a baby. And so that's one example of how it can go. The other third of people say that they are discomfort and gender dysphoria lessens. About a third stay the same. That was me. I got pregnant and I was like, this is cool. Weird. For me I was just like science and so I didn't experience any heightened or lessened dysphoria. It was just the same. It was like, here's my body is doing this cool thing, Rad. And then about a third do experience heightened dysphoria. So it is very emotionally, psychologically difficult for them to see their body changing in a way that some people might consider to be more in alignment with a more feminine body shape. I of course don't see it that way. So there's a variety of experiences in the end. The data really bears that out.

Emily: Shifting a little bit then. I would love to hear your thoughts on some of the ways that partners, family members, and community members supported you in the prenatal and also really importantly in that postpartum experience.

Trystan: My partner and I had a bit of a stumbling block because I just hadn't communicated to him like this is what I need from you. This is what allyship is going to look like to me throughout this process. And the one incident that I specifically remember was we had an ultrasound technician who was fine when she was giving me the ultrasound and when I left the room in my absence, she used the wrong pronouns for me when she talked to my partner. And for some reason that I don't understand, he decided to share that with me when I came out of the bathroom. Which pro tip number one, just don't tell us. If it doesn't happen, if we don't hear it. No need to tell us that. But anyways, he told me, Oh, the ultrasound technician called you 'she' when you were in the bathroom. And I was like, are you serious? And so then we went into the to the next meeting, which is with the OB who oversees the whole department. And I told him, your ultrasound technician used the wrong pronouns for me. And my expectation is that the next time I come back in, you'll have given her all the support she needs to make sure that that doesn't happen again. And if you need a recommendation for somebody you can hire to train your staff so this doesn't happen to anyone ever again, I'm happy to give you the name of someone that you can pay to do that. Then my partner jumps in there with like, oh, but we understand, most people who get pregnant are women and it's probably just habit. And we know that you guys don't mean to. And I was like, okay, if we're doing good cop, bad cop, I get to be good cop. You're bad cop. That's how allyship works in this situation. That's how I want it to work. But I realize, okay, I didn't make that clear. And so when we left I was like, so I don't want you to make excuses for people when I'm doing the brave and hard work of holding them accountable for the ways in which they are not showing up for us in the way that we deserve. Don't really need you to undercut me in that. And he was like, oh my gosh, I'm so sorry. I thought I was making it easier. I was like, no problem, but moving forward, this is what I want from you. You handle it. So yeah, that was a big learning that we had and I would give to other people, which is just like really do some intentional thinking. What do I want? What do I need? What do I want to handle? What do I want other people to handle?

Trystan: And ask for help a billion times. Never be ashamed or embarrassed. The worst they can say is no. No one is ever going to be offended that you were like, Hey, I just had a baby. Can you come and make me some tea? Hey, would you by any chance to be able to do a sleepover and feed the baby overnight so I can get a solid eight hours of sleep one night? Maybe they can't do it, but no one's ever going to be mad at you for asking them that ever. They're going to be mad at you when two years later you're like, yeah, I had really bad postpartum depression from not sleeping and no one helped. They're going to be like, fool, why didn't you call me? I would've loved to help. People really want to help. They really want to show up. I found that in medical spaces, finding that cool person and then saying like, Hey, I had a hard time with this other person. Can you, can you deal with them? People want to do to be in allyship, they want to show up for you. So I think just asking for what you need and taking yes for an answer when people say that they want to help.

Jesse: I think that the best advice anyone gave me about what to do pre and post-partum was never say no when someone offers to help. I was very fortunate that there were a lot of people there to help me, including of course my partner. Tristan, I think what you brought up about what allyship looks like is important because when you're say in labor you can't advocate for yourself or can't do it very effectively. And I know that when I was in labor it meant the world to me to have my partner there and to have my mom there and to have my doula there who's queer. They were all advocating for me when I was in no position to do that. They were correcting people's pronoun usage. They were making sure that we were both called dads, as well as advocating for just pregnancy stuff that everybody faces. But you know, when we're trans, there's a lack of cultural competency sometimes and our allies, whether they be family members or friends or hired professionals, can help fill that gap and advocate for us when we aren't in the position to do that for ourselves.

Emily: That's actually a perfect segue. Thank you Jesse. A while back we put out a call out for some questions from folks on social media. Kim on Instagram is a social worker and was wondering what other resources would be helpful for trans parents to have access to? So what were some of those other resources that you either accessed or just what you think would be important to have more competency and allyship in those broader social resources?

Jesse: Well, one resource that I accessed while I was pregnant was a government program for pregnant women. And I'm really glad that I had access to that. We were going through a period of low income when I got pregnant. I was very happy to be pregnant, but I was also worried because the timing wasn't ideal. So I think it's really important that that all the resources in our community that are for expectant parents are accessible to trans people. You know, we are more likely than cisgender people to be low income and we need to be able to access those resources. It can be a little daunting to constantly be applying for resources that are for women that have women and mother and the title. And you just have to do that to get what you need.

Trystan: There's one really great study out of the UK which really looks at the medical experiences of trans gestational parents. And they really pulled out that there are three main areas of psychological care during the process that need to be in place. One is that there is a place where the person is having their identity affirmed. So they're being called by their right pronouns, are being called by their right name. All of that. Next is a place where someone could have their pregnancy affirmed. So they need to be able to talk about their pregnancy. They need a place where they can ask, is this normal? Is this usual? What should I expect? All of that. And then finally they need a sense of physical and psychological safety. You just cannot feel like you are under attack. That is going to have ripple effects throughout all other aspects of your life, including well into postpartum. Ideally people have all three of these things all the time, but we don't live in that world.

Trystan: And so what we see is that some trans parents, especially those who have not taken hormones prior to becoming pregnant, they actually choose to allow the world to see them as a cisgender woman. And in that way, they're able to have their pregnancy affirmed. They're able to get support around their pregnancy and they're able to feel safe. But unfortunately then they are not having their identity affirmed. And so that can be really psychologically challenging for people. Some people choose to go stealth as a cisgender man and not tell most people that they're pregnant, which is great. They have their gender identity affirmed, they're much safer. But then you have so many fewer people to talk to about actually being pregnant. You don't get to sit at the front of the bus even if you feel super nauseous. And those things seem small, but they really do add up in terms of cutting you out of the access that our society has created for helping make pregnancy a little easier for people. Or you can out and proud as a trans pregnant person as I was, which means that your identity is affirmed, your pregnancy is supported, but you are really unsafe. So you can't really have all three of those things. But I think any program, any kind of supportive systems should be thinking about those three aspects. And ideally all three of them are. And so when you go into a clinic, no matter what kind, whether it's a federal thing or a doula's office or a midwifery clinic or a birthing center or whatever, does every person have their identity, their gender affirmed? Are they supported in their pregnancy? And are they going to feel safe? And I think if you apply that lens to all of your work, right action comes from that.

Trystan: Family Equality has now built several programs to help providers be better at providing those three things to the people that they support. Over 1,200 providers around the country have gone through at least one of our online training modules dedicated to helping them learn more about how to be supportive of the LGBTQ+ community in general as they're family building. And then specifically trans people who are going through fertility processes. But that's a tiny drip in the ocean of providers. To fill in the gap, I think about two other things. One, I think about supportive people, professional support, people such as doulas. I do a doula trans birth training because I think doulas are a great way to bridge that gap while we're waiting for the providers to catch up. Let's get some people in there who can help do that sort of bridging so that people who are in labor don't have to do it. And then I think the third thing is I'm thinking more and more intentionally about what does it mean to actually build the resiliency and self-advocacy skills of the trans community? Specifically so that we have healed our wounds around medical trauma, around our identities, around our bodies. So we're better able to show up in those medical spaces and say, I don't like the language you're using. I want you to fix your form. Please don't use that word when you talk to me. I want you to do this instead. We need to have some of those self-advocacy skills while we're waiting for providers to catch up. And not everyone can afford a doula or has access to one in their community. I think all three things need to be happening. So those are the sort of three big things that I'm thinking about and working on when it comes to making sure that people have the support they need.

Emily: Amazing. Thank you both so much. Any other final thoughts for listeners?

Jesse: You know, we need support, we need love, we need resources just like everybody else, but we also, we need to be treated with respect and we need to be seen as whole people.

Trystan: I think what I usually share with any LGBTQ+ person who wants to become a parent is to hold tight to your vision of having a family. And hold lightly to how you're going to get there. Because there are so many mysteries in the human body. It may not happen for you biologically. The world may have a different plan for you and there may be a kid sitting in foster care or sitting in a group home right now who in a way is waiting for you. I just saw a show last night on Netflix where there's an adoptive parent and he's talking to his grown daughter and he says, you know, even though I wasn't there when you were born, I was always your dad. And I'm an adoptive parent and I feel that way about my kids too. Even if you've lost that ability or it doesn't happen for you in that way, a family will happen if you want it to. And there will never be a time when you look at your kids and you're like, you know, I wish I had had different kids. No, no, no. You will always say, oh, of course. Of course. And thank God you're here.