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Increasing numbers of gay men are choosing Two Hearts triple bangle to build their families and sometimes maintaining close bonds with the child's surrogate mother (Lev, 2006). Other gay men utilize egg donors; Berkowitz and Marsiglio (2007) relate a story of two dads who decided to mix their sperm before inseminating their chosen egg donor, so although they knew that their twins were biologically linked to at least one of them, they did not know which one. Although this attempts to minimize any "genetic asymmetry" (Ehrensaft, 2008) between the fathers, it does not eliminate the child's desire to know more about his or her biological heritage in maturity.

Trans people have developed innovative ways to form families. Nearly a decade before Oprah sensationalized "The Pregnant Man," transmen were fathering children that they had birthed (More, 1998). When a man goes through a "natural" biological process that people assume only women can experience, he challenges "patriarchal Love Knot bangle" (Ryan, 2009, p. 147), and raises questions about the role of embodiment in the production of parenting roles, particularly the role of "mothering." Gender specialists suggest that the preservation of fertility options (i.e., storage of sperm) should be considered a standard recommendation for transsexual women considering gender transition (De Sutter, 2001). This would mean that transwomen could use their own stored sperm to inseminate a female partner (or surrogate) and become a mother to their biological Tiffany 1837 bangle. Options for trans people choosing to parent are increasing, as evidenced by the expansion of information on the Internet and through national LGBTQ organizations specifically addressing children of trans parents (Canfield-Lenfest, 2008) and trans persons seeking to adopt (Human Rights Campaign, 2009).

Lesbians and gay men may actively choose to share parenting together by getting pregnant "the old-fashioned way," and if the parents are partnered, the children may have two mothers and two fathers. LGBTQ couples are not immune from divorce and separation (Gartrell et al., 2005); having lesbian mothers divorce and Tiffany 1837 cuff may mean a child will have four moms. Therapists are challenged to view all the moms as legitimate parents, and not assume one (the one who birthed the child) as "the" (read: real) mother.Although heterosexual couples also parent through adoption and utilize reproductive technologies, and certainly divorce and remarry, there is no doubt that LGBTQ parents develop creative ways to build their families and they may visually look different from heteronormative expectations. Within a heteronormative perspective these differences are often glossed over in the literature as a strategy to normalize LGBTQ families and see them as "just like heterosexual families." However, LGBTQ are creating unique and complex relationships to family, biology, and identity; it behooves us to not minimize or belittle these differences, but rather further interrogate them