Pathways and Roadblocks: Navigating Family‐Building for Sexual and Gender Minority People Assigned Male at Birth

INTRODUCTION: Sexual and gender minority (SGM) individuals assigned male at birth (AMAB) remain underrepresented in family-building research despite facing unique barriers to having children, especially when they are single or in partnerships where neither person can carry a pregnancy. This qualitative study examined the family-building experiences of cisgender sexual minority men, transgender women, and nonbinary people AMAB. METHODS: We conducted 10 asynchronous online focus groups with 56 participants (23 parents, 33 prospective parents) across three gender groups (22 cisgender sexual minority men, 18 nonbinary people AMAB, 16 transgender women) at different phases of their family-building journey. Participants answered a series of writing prompts related to parenthood, family-building, and raising children. Data were analyzed using template analysis to identify cross-cutting and group-specific themes. RESULTS: Participants had used or were considering a diversity of methods to have children, including sexual activity, medically assisted reproduction, surrogacy, adoption, and fostering. Participants' preferences for and the accessibility of each of these methods were influenced by intersecting issues of identity, systemic inequities, and cultural belonging. Financial constraints were pervasive, as were concerns related to legal parentage and discrimination. Race and ethnicity profoundly shaped participants' decisions, including preferences for race-concordant gamete donors and experiences of discrimination within fertility and adoption settings. CONCLUSION: Our findings reflect the diversity of family-building goals and priorities within SGM communities and underscore the importance of inclusive reproductive health services. This comparative examination of family-building among cisgender men, transgender women, and nonbinary individuals AMAB revealed both shared and unique barriers to parenthood.