A transgender man legally married to a woman has given birth to two children, raising questions about the ethics of assisted reproductive treatments (ARTs) for people with cross-sex identities. Psychiatry treats cross-sex identities as a disorder, but key medical organizations and the law in some jurisdictions have taken steps to protect people with these identities from discrimination in health care, housing, and employment. In fact, many people with cross-sex identities bypass psychiatric treatment altogether in order to pursue lives that are meaningful to them, lives that sometimes include children. Cross-sex identification does not render people unfit as parents, because transgender identities do not undercut the ability to understand the nature and consequences of pregnancy or necessarily interfere with the ability to raise children. Moreover, no evidence suggests that being born to and raised by transgender parents triggers the kind of harm that would justify exclusion of trans-identified men and women from ARTs as a class. The normalization of transgender identities by the law and professional organizations contributes, moreover, to the need to reassess pathological interpretations of cross-sex identities, and trans-parenthood puts those interpretations into sharp relief.