Medically Speaking: Birth Control & Gender-Affirming Hormone Therapy
Many misconceptions exist among patients and providers alike regarding the need for contraception while taking gender-affirming hormone therapy. The bottom line: gender-affirming hormone therapy is not a reliable source of birth control! For transmasculine and nonbinary people who were assigned female at birth (AFAB) and have an intact uterus & ovaries, ovulation can still occur on testosterone therapy even if menstrual periods stop entirely. For transfeminine and nonbinary people who were assigned male at birth (AMAB), sperm production can still occur on estrogen therapy. For that reason, it is important to understand that pregnancy can still occur on hormone therapy if two people are having unprotected penis-in-vagina sex without an additional birth control method. It is also important to keep in mind that testosterone can cause birth defects to a fetus. This is another reason why birth control is essential to use when taking gender-affirming hormones (particularly testosterone).
But which method is best?
There isn’t one correct answer! Trans and nonbinary people who were assigned female at birth (AFAB) have all the same birth control options that are available to cisgender women, even if taking testosterone. It is important to review these methods with a healthcare provider as some options might be more appropriate than others due to underlying medical conditions. Also keep in mind that copper IUDs and hormonal birth control do not protect against sexually transmitted infections (STIs). For that reason, it is wise to always use a barrier method such as condoms or dental dams!
Author: Zoë Curry (she/her/hers) is a 4th year medical student at the University of Michigan Medical School.
Amato, Paula. Fertility options for transgender persons, UCSF, 17 June 2016, transcare.ucsf.edu/guidelines/fertility.
Navigating Birth Control When You’re Trans or Nonbinary, Yoppie, yoppie.com/blog/birth-control-nb-trans.
Ray, Laurie. What trans and nonbinary people need to know about birth control, Clue, 27 June 2019, helloclue.com/articles/culture/what-trans-and-nonbinary-people-need-to-know-about-birth-control.