The demand for a uterus transplant among transgender women (a survey study)

 A couple of years ago I gave a Department of Surgery Grand Rounds (a dawn seminar) at Stanford. Much later in the day, at dinner with transplant surgeons and others, someone asked me what other kinds of work I did.  So I started to tell them about my work on repugnant transactions and controversial markets, and used surrogacy as my main example. I pointed out that Sweden, where surrogacy is illegal, had pioneered uterus transplantation as an alternative that worked for some. But I suggested it wouldn't work for same-sex male couples, who are among those who use the well established legal market for surrogates in California.  The conversation quickly turned to why I was wrong.  As I recall what they said, the uterus is just a muscle, so could be transplanted into a man. Ovaries would be a problem, so in-vitro fertilization (IVF) would be needed to start the pregnancy, and of course the baby would have to be delivered via a C-section...

Since then, uterus transplantation has become somewhat more widespread, from both living and deceased donors.  As far as I know, no one is actually proposing to transplant a uterus into a man--for one thing, the demand may not be there.  But that's not the case with another group of people born without a uterus, namely transgender women.

Here's a recent survey from JAMA on just that, which shows that in fact there are transgender women who are open to bearing a child through a uterus transplant:

Jones BP, Rajamanoharan A, Vali S, et al. Perceptions and Motivations for Uterus Transplant in Transgender Women. JAMA Netw Open. 2021;4(1):e2034561. doi:10.1001/jamanetworkopen.2020.34561

"Key Points

"Question  What are the perceptions and motivations of transgender women for uterus transplant?

"Findings  This survey study of 182 transgender women found that to more than 90% of the respondents indicated that uterus transplant may improve quality of life in transgender women, alleviate dysphoric symptoms, and enhance feelings of femininity.

"Meaning  This report on the desire and willingness of transgender women to undergo uterus transplant may support the need for further animal and cadaveric model research, which is necessary to assess the feasibility of performing this procedure in transgender women"