What You Need to Know About Birth Control if You’re Transgender or Nonbinary

No matter where you fall on the gender spectrum – whether you’re transgender (trans), non-binary, genderqueer, or gender non-conforming – you might need birth control, especially if there is a chance that you could get pregnant and don’t try. at.

Even if you’re on gender-affirming hormone therapy – a type of treatment that helps align your sex characteristics with your gender identity – it won’t work very well as birth control. If you have ovaries and a uterus, and you have vaginal sex with someone who has testicles and a penis, you could get pregnant.

Still, there are other reasons why you might take birth control (you might hear it called contraception). For example, gender dysphoria – the feeling that your sex does not match the sex you were assigned at birth – can get worse if you are a non-binary or trans male and start your period. Some birth control options can reduce or stop your period.

All of the birth control options used by cisgender people are available to non-binary and trans people. Still, some are better than others, depending on what other medications you are taking.

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“If it’s for a patient with no other risk factors, any option is available,” says Beth Cronin, MD, obstetrician-gynecologist in Providence, RI. It depends on your goals and what side effects you are ready or able to live with.

This is where contraceptive advice can help.

If you want to avoid pregnancy, contraceptive counseling can help you match your contraceptive with your family planning values ​​and reproductive goals, says Adam Bonnington, MD, an obstetrician-gynecologist in San Francisco.

Who needs birth control?

Not all transgender people choose to make the transition using gender-affirming surgery or hormone treatments. You should discuss parenting and fertility decisions with your partner beforehand.

Doctors recommend birth control for most transgender men and women and non-binary people who have vaginal sex and don’t want to get pregnant.

Transmasculine people

If you are a transgender or non-binary male, have vaginal sex, and have not had a hysterectomy or bilateral oophorectomy (where the doctor removes your fallopian tubes and ovaries), you should use a contraceptive method. Testosterone (T) therapy – a treatment that reduces feminine characteristics and brings out masculine characteristics – does not prevent pregnancy.

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People often think that if they don’t have a period, they can’t get pregnant. It’s unlikely, but it’s not impossible, says Cronin. “We generally advise patients that if they are on T and have this type of sex, they could get pregnant and they should use contraception.”

If you are transmasculine, taking testosterone and want to get pregnant, you will need to stop taking it.

Transfeminine people

Some transgender or non-binary women receive treatment with estradiol – a treatment that causes changes in your body caused by female hormones. It can help align your body’s physical characteristics with your gender identity, but it won’t work as birth control if you have vaginal sex. Hormone therapy either, because it doesn’t completely stop the sperm you make.

Types of hormonal therapies that are not birth control methods include:

  • Cyproterone acetate
  • Finasteride
  • Gonadotropin releasing hormone (GnRH) analogues

If you haven’t had a vasectomy (when a doctor cuts and seals the tubes that carry semen) or orchiectomy (when a doctor removes your testicles), make sure your partner is using birth control if you are having vaginal sex and you don’t want it. get pregnant.

Types of birth control and how to use them

How you will use birth control depends on which method you and your partner choose.

The type that’s right for you may not be right for someone else.

Things that can affect your decisions include:

  • How easy to use
  • How much does it cost
  • Possible side effects
  • Any misconceptions you have about it
  • Things that make contraception difficult
  • Discrimination
  • Your relationship with your doctor

Always talk to your doctor before adding anything new to your regimen.

Condoms

Condoms are a popular form of birth control, but they are not 100% effective in preventing pregnancy. If you use condoms, be aware that you or your partner may still be pregnant. If you use them the right way every time, there is a 2% chance that they will fail. The typical failure rate for people who use condoms is around 18%. You can use condoms with birth control to protect yourself from STDs.

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IUD

Another option is non-hormonal copper intrauterine devices (you might hear them called Cu-IUDs). These are completely safe to use and will not interact with any hormonal treatments you may be receiving if you are a non-binary or trans male. But there may be some side effects you don’t want, like vaginal spotting (where there is only a little blood) and bleeding.

Progestin-only methods

If you want to use progestin-only birth control methods – such as levonorgestrel intrauterine systems (IUS), implants, injections, or pills – talk to your doctor first. Some doctors don’t think this will affect the hormone treatments you may receive if you’re trans or non-binary, but others don’t recommend it.

Given the lack of data on the potential risks, side effects, and benefits specific to transgender and non-binary people using gender-affirming testosterone in combination with estrogen-containing contraceptives, Bonnington says it’s best to avoid these. products unless there is a clear benefit or you have a strong preference.

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Injections or the IUS can help stop or reduce vaginal bleeding.

If you want to avoid bleeding, you may want to choose a method like progestin-only implant, intrauterine system, or injection, says Bonnington.

Combined hormonal contraceptives (CHCs)

Transgender men and non-binary people on testosterone treatment should not use combined hormonal contraceptives (CHCs) – patches, pills, or vaginal rings – that contain estrogen and progestins. This is because CHC has estrogen, which can potentially interfere with testosterone.

If you have had high-level surgery (where a surgeon removes breast tissue to create a more masculine breast), estrogen-containing drugs, such as birth control pills, patches, or the ring, may cause tenderness or pain. breast pain. “Some people notice bloating and things like that, but it’s really going to depend on the person,” Cronin says.

More permanent options

There are also more permanent forms of birth control. Either partner may have a vasectomy or tubal ligation (where a surgeon ties, cuts, or blocks your fallopian tubes). Both procedures will help prevent conception.

How to talk to your doctor’s office and pharmacy

According to a recent study, around 56% of lesbian, gay or bisexual people and 70% of transgender people say they have experienced discrimination when seeking health care.

Sometimes the best way to find LGBTQ-friendly providers is through word of mouth from family or friends, Cronin says. Local LGBTQ organizations often have a list of providers to which they refer their patients, adds Bonnington.

Signs that the provider is LGBTQ-friendly include:

  • A clearly displayed sign with non-discrimination policies that include gender identity and the protection of expression
  • A waiting room with educational brochures, magazines or posters on transgender health
  • Bathrooms labeled for all types of use
  • Admission forms that ask for your correct name, pronouns, gender identity and sex assigned at birth
  • Suppliers who have their pronouns on their name badges

Yet, he says, these are no guarantees that a provider or clinic is LGBTQ-friendly.

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