Reproductive Health Care for Trans People

Health care decisions are among the most important and personal decisions a person can make. But it’s hard to make informed decisions if you’re transgender and your medical provider isn’t well versed in gender identities. Many learn through trial by fire; or the burden falls on the patient to teach the medical provider how to best care for them. This lack of access to providers who are sufficiently knowledgeable on the topic is one of the biggest barriers to safe hormonal therapy and general medical care reported by transgender individuals.

Read: 5 Tips for Going to the Gynecologist as a Non-Binary Person

Finding a Health Care Provider

“When you visit your healthcare provider, you deserve to be addressed with the correct name and gender and treated with respect and dignity."

If your healthcare provider is not understanding, or you don’t feel comfortable with them, Brayboy says find a new one — there are several ways to find a provider with whom you connect. “To start, ask people you trust for recommendations. Friends, local support organizations, and online forums are all good sources for this information. You might want to ask another healthcare provider with whom you had a good experience.”

Alternatively, the World Professional Association for Transgender Health offers a list of recommended healthcare providers worldwide, and there are many more organizations working at a local level, too.

In the US and Canada, MyTransHealth, RAD Remedy or The Gay and Lesbian Medical Association are excellent resources for transgender and nonbinary people looking for healthcare.

If you’re nervous about your first appointment, many online articles share insight into what you can expect during your first OB/GYN appointment.

In addition to limited medical training (not to mention the potential bias a transgender person may face during an initial patient visit), there are significant blind spots when it comes to transgender reproductive health. “Currently, there is very little research data to inform trans people of their reproductive care and contraceptive choices, and very few health care professionals with clinical expertise in transgender reproductive care, which also includes pregnancy, fertility, and sexual function,” says Brayboy.

"Currently, there is very little research data to inform trans people of their reproductive care and contraceptive choices."

Now, Brayboy thinks it is time for the mandate to be re-evaluated, to make sure all genders are included. “There are an estimated 1.5 million trans people in the United States, but unfortunately there is really sparse data about transgender individuals across the field of reproduction—and even emerging research (such as a study on ovulation during testosterone therapy by Taub et al. which was published in 2020) concludes that further studies are needed,” says Brayboy. “It would be fantastic to see these studies being carried out, especially as they are vital to the advancement of proper reproductive health for trans people all over the world.”

Testosterone Therapy and Birth Control

For trans men, gender-affirming testosterone therapy is meant to produce desired, masculine characteristics such as a deeper voice or facial hair. Brayboy notes that one side effect of testosterone therapy, which is also sometimes considered a desirable outcome for trans men, is amenorrhea, or the absence of spontaneous periods.

However, Brayboy stresses an important detail—testosterone is not a contraceptive and people can become pregnant despite not having a period. “This means that reliable contraception is still very important for transgender men, even when taking testosterone—although it is sometimes a health issue which can be overlooked,” she says.

There is no clinical consensus on what the most appropriate contraceptive option is when it comes to the transition process. “It has been reported that no contraceptives are contraindicated, or unadvisable to use, for trans men,” says Brayboy. A very commonly prescribed method is the oral contraceptive pill. “Both components of the oral contraceptive pill (a synthetic estrogen called ethinyl estradiol and a synthetic progesterone called progestin) work independently to impede the production and effect of androgens (hormones associated with male characteristics, like testosterone and androstenedione) that are made naturally by the ovaries and adrenal glands. Therefore, there is a possibility combined oral birth control pills could negate the desired gender-affirming therapy for people assigned a female at birth who are now transitioning to male.”

Brayboy says there isn’t enough data to really know with certainty whether this is the case. “This is why we need further clinical research, and better enrollment of trans men in contraceptive studies in general: so we have more data.”

Read: We Asked An Expert: Which Birth Control is Best?