Family planning and contraception use in transgender men

Objectives: Female-to-male (FTM) transgender men (affirmed males) can experience planned and unplanned pregnancy during and after testosterone therapy. We conducted an exploratory study to understand current contraceptive practices and fertility desires among transgender men during and after transitioning.

Study design: Self-identified transgender and transmasculine individuals assigned female at birth, ages 18-45, completed an anonymous online survey derived from standardized family planning surveys. We recruited participants from LGBT health centers, online listservs, and online groups for transgender men and used a mixed-methods analysis to evaluate quantitative and qualitative data.

Results: Of the one hundred and ninety-seven participants included in the study, the median age was 30 years old, most respondents were white, and 86% were taking masculinizing hormones (testosterone). Of the 60 pregnancies reported, 10 (17%) pregnancies occurred after stopping testosterone, 1 (1.6%) while taking testosterone irregularly, and 5 of 7 abortions occurred in participants who had been using testosterone in the past. Over half of the respondents desired at least one child, and a quarter reported fears of not getting pregnant. The majority of participants reporting using contraception (n=110, 60.1%), with condoms and pills used most commonly (n=90, 49.2% and n=62, 33.9% respectively). Methods of contraception used did not differ between testosterone users and non-users, except for hormonal IUDs (20% testosterone versus 7% non-testosterone). Thirty participants (16.4%) believed that testosterone was a form of contraception, and 10 (5.5%) participants reported that their healthcare providers advised testosterone as contraception.

Conclusion: Transgender men use contraception and can experience pregnancy and abortion, even after transitioning socially and hormonally. Transgender men need counseling and care regarding reproductive health, including contraceptive and conception counseling.

Implications: Providers should be aware that transgender men may desire pregnancy and use contraception; this study highlights the need for further research regarding fertility, fertility desires, and optimal contraception among transgender men.