Trans Men Require Comprehensive Contraception Counseling

By Will Boggs MD

August 30, 2019

NEW YORK (Reuters Health) - Transmasculine individuals require comprehensive, gender-affirming contraception counseling, and more research is needed to provide optimal recommendations, researchers say.

"Pregnancy risk should not be assumed based on gender identity," Dr. Frances Grimstad of Boston Children's Hospital told Reuters Health by email. "For those who are at risk, transmasculine considerations should be incorporated in counseling, to help patients select the most appropriate method."

Transgender men and gender-nonbinary persons assigned a female gender at birth who are taking testosterone can still have unintended pregnancies, and both patients and clinicians lack knowledge about the need for contraception among transmasculine persons taking testosterone.

Dr. Grimstad and colleagues sought to offer comprehensive guidance for managing contraception in transmasculine patients in report, online August 5 in the American Journal of Obstetrics and Gynecology.

While testosterone therapy impairs ovulation, it doesn't completely prevent it, the team writes. And there is no current research regarding whether the impact of testosterone on the hypothalamic-pituitary-gonadal axis in people who still have ovaries impairs the efficacy of contraception.

Contraceptive options for transmasculine individuals include the full range of options available for cis-gender female individuals, and whether contraception is indicated depends upon which organs are present, whether pregnancy is desired now or later, and whether the individual's sexual practices put them at risk for pregnancy.

The authors provide suggested questions and language to be used when taking a gender-inclusive sexual history, as well as less gendered sexual health language options.

Transmasculine people at risk for pregnancy should also be counseled about the availability of emergency contraception.

Important considerations in contraceptive counseling include gender dysphoria, the desire of some patients to avoid contraception that requires a pelvic procedure, the desire of some patients to avoid estrogen and/or progesterone due to perceived feminizing effects of these hormones, the patient's attitudes on menstruation, the ease of discontinuation, and other factors.

"Testosterone does not protect from pregnancy, and all forms of contraception should be offered to transmasculine persons at risk," Dr. Grimstad said. "All current data on efficacy and side effects of contraception comes from cis-females; more research is needed to improve the guidelines for expected effects in transmasculine persons."

"Transmasculine healthcare leaders should be at the forefront of this work (just as they were at the forefront of the creation of these recommendations)," she said.


Am J Obstet Gynecol 2019.