- Open Access
Biotechnologies that empower transgender persons to self-actualize as individuals, partners, spouses, and parents are defining new ways to conceive a child: psychological considerations and ethical issues
Philosophy, Ethics, and Humanities in
- Open Access
Biotechnologies that empower transgender persons to self-actualize as individuals, partners, spouses, and parents are defining new ways to conceive a child: psychological considerations and ethical issues
Philosophy, Ethics, and Humanities in Medicine volume 13, Article number: 1 (2018)
Today, thanks to biomedical technologies advances, some persons with fertility issues can conceive. Transgender persons benefit also from these advances and can not only actualize their self-identified sexual identities but also experience parenthood. Based on clinical multidisciplinary seminars that gathered child psychiatrists and psychoanalysts interested in the fields of assisted reproduction technology (ART) and gender dysphoria, philosophers interested in bioethics, biologists interested in ART, and endocrinologists interested in pubertal suppression, we explore how new biotechnical advances, whether in gender transition or procreation, could create new ways to conceive a child possible. After reviewing the various medical/surgical techniques for physical gender transition and the current ART options, we discuss how these new ways for persons to self-actualize and to experience parenthood can not only improve the condition of transgender persons (and the human condition as a whole through greater equity) but also introduce some elements of change in the habitual patterns of thinking especially in France. Finally, we discuss the ethical issues that accompany the arrival of these children and provide creative solutions to help society handle, accept, and support the advances made in this area.
Today, biomedical technologies enable persons with fertility issues to conceive. In the field of gender dysphoria (GD), they have allowed persons to change sex and adopt the gender they identify with. Additionally, assisted reproduction technologies (ARTs) in the 80’s has impacted family law and created new ways for transgender persons to participate in parenting. Furthermore, the fight for equality and non discrimination has led to a better recognition of the rights of Lesbian-Gay-Bisexual-Trans-Intersex-Questioning (LGBTIQ) including in family law.
This paper is based on clinical multidisciplinary seminars that gathered child psychiatrists, psychoanalysts, philosophers, biologists, and endocrinologists interested in GD and ARTs during the year 2016, in which we shared our experiences and read numerus texts on this issue. We aimed at tackling the novel issues raised by those new ways for couples (in France ARTs are not available for single person), including transgender persons, to access fertility services in order to conceive a child (see Additional file 1: Glossary). Here, we first reviewed  the various medical/surgical techniques for gender transitioning and  the ART options that make new ways of conceiving possible. To this aim, we performed 2 theme searches on the last 10 years (2007–2017) in Pubmed and Psychinfo databases. The first on gender dysphoria used the following key-words (gender dysphoria and transition, gender dysphoria and ethics, gender dysphoria, LGBTIQ health, transgender people and transition, transgender people and ethics, puberty suppression, gender reassignment) and selected articles referring to self-actualization and ethical issues. The second on ARTs used the following key-words (transgender people and assisted reproduction technology, transgender people and reproductive issues, gender reassignment and assisted reproduction, fertility preservation, uterus transplantation, artificial gametes, transgender people and fertility, assisted reproduction technology and ethics, reproductive wish and trans) and we selected articles focusing on transgender persons and procreation and ethical issues. We also added key references on GD and ART that had been outlined by our experts during the seminar. These selected texts were discussed at the clinical multidisciplinary seminars.
Then, we pounder how these new opportunities, in addition to bringing a real improvement to the lives of transgender persons, would introduce some elements of change in patterns of “traditional thinking”. Finally, we discuss according the Beauchamp and Childress Principlism  the ethical issues that accompany the arrival of these “children of science”  and provide creative solutions to help society come to terms with the advances in this area.
It is now possible for persons who perceive themselves as transgender to align their anatomical attributes in order to be closer to the gender with which they identify. Social and cultural perceptions of transgender affirmation have evolved (Additional file 2 Supplement-e1). Today, the concept of sex is biological whereas the meaning of gender refers to two concepts : ‘gender role’ which refers to what one says or does to disclose one’s status of boy/man or girl/woman, and ‘gender identity’ as the intimate sense of belonging to one’s sex [5, 6]. Gender dysphoria (GD) refers to a marked incongruence between one’s experienced/expressed gender and one’s assigned gender, leading to clinically significant distress. The term “transsexualism” has been used in the past to describe persons who have social transition to another gender. This term has largely fallen out of favor and is considered pejorative by many.
If one’s identity is constructed by a 