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Contraception across the transmasculine spectrum
Chance Krempasky1, Miles Harris2, Lauren Abern3
1Callen-Lorde Community Health Center, New York, NY.
American Journal of Obstetrics and Gynecology
|August 9, 2019
Summary
Transmasculine individuals on testosterone may still ovulate and become pregnant, even when amenorrheic. This study provides clinical guidance on contraception for transgender men and gender-nonbinary individuals to improve reproductive health.
Area of Science:
- Reproductive Health
- Transgender Health
- Contraception
Background:
- Research on transgender family planning often overlooks pregnancy prevention for transmasculine individuals.
- Many clinicians and transmasculine individuals incorrectly believe pregnancy is impossible during amenorrhea (absence of menstruation) while on testosterone therapy.
- Current contraceptive counseling for transmasculine individuals is inconsistent and lacks robust clinical guidance.
Purpose of the Study:
- To consolidate existing research and offer comprehensive clinical guidance for managing contraception in transmasculine patients.
- To address the unique contraceptive needs and concerns of transgender men and gender-nonbinary individuals.
- To provide a model for contraceptive counseling tailored to the transmasculine population.
Main Methods:
- Review of the physiological effects of testosterone on the reproductive axis.
- Analysis of current understanding regarding ovulation and pregnancy risk during amenorrhea.
- Inclusion of gender-inclusive terminology and a script for gender-affirming sexual history.
- Evaluation of contraceptive methods' effects on gender dysphoria and affirmation.
- Development of guidelines led by reproductive care clinicians with transgender experience.
Main Results:
- Testosterone's effects on the reproductive axis do not always prevent ovulation and pregnancy during amenorrhea.
- Contraceptive counseling practices are inconsistent, and clinicians often lack adequate training.
- Transmasculine individuals have unique concerns regarding contraception, including effects on gender dysphoria and affirmation.
Conclusions:
- Comprehensive clinical guidance is needed for transgender men and gender-nonbinary individuals regarding contraception.
- Healthcare providers require better training in transgender reproductive health to offer effective care.
- A structured approach to contraceptive counseling is essential for selecting appropriate methods for transmasculine patients.
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