Transmasculine reproductive healthcare is rarely talked about. Let’s change that.

“Getting kids to understand queerness is not nearly as hard as people think, and they will often answer the questions for you, which is entertaining. Watching a seven-year-old tell a grown man [about parental transitioning] ‘Because they can, duh’ is a delight,” a transgender man with kids tells LGBTQ Nation. He will be referred to as Damien for anonymity.

One of the unfortunate realities of transitioning is that, unless your doctor has researched specific health questions to better understand trans people, you’re going to be likely shooting in the dark. This is especially the case if you’re transmasculine, nonbinary, and/or gender non-conforming (TGNC) in the realm of reproductive healthcare.

Related:

What happens when a transgender man needs Plan B?

It gets complicated quickly – and the Supreme Court hasn’t even ruled on abortion yet.

“A lot of trans people end up either giving up or having to fight tooth and nail to have [reproductive healthcare] covered by insurance,” says Damien.

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Nearly 20% of trans people have kids, according to the Williams Institute. It’s a rewarding path to go down, one that you can draw from the broader community to learn about the unique challenges trans parents face. Additionally, there are a multitude of options for TGNC individuals to have kids.

Getting pregnant

TGNC individuals and cis women can get pregnant through the same means, and there are no differences in the currently available fertility options. Of course, there are immense differences in access to care and experiences with discrimination along gender lines.

“TGNC individuals who desire to have kids have various options, including methods that use their own genetic material (technically known as oocytes and more commonly referred to as ‘eggs’) and those that don’t,” says Dr. Jerrica Kirkley, co-founder and chief medical officer of the gender-diverse virtual health clinic Plume.

“For folks who are not concerned about having a child that is ‘genetically’ or ‘biologically’ related, adoption is a great option. For those who want to use their own genetic material, options include carrying the pregnancy on their own after conception with a partner, or from intrauterine insemination (IUI) or in vitro fertilization (IVF) through a sperm donor.”

Fertility preservation, where eggs are frozen, opens up working with a surrogate as an option. Another is vitro fertilization (IVF), where an egg is removed and artificially inseminated and then put back into a person’s body.

Testosterone and pregnancy

TGNC individuals can get pregnant even if they’re on testosterone, contrary to the myth that a lack of menstruation indicates a lack of fertility. Current research shows mixed evidence with respect to testosterone’s impact on pregnancy likelihood, but as Planned Parenthood discusses, testosterone is not a supplement for birth control. All that’s required for ovulation is a uterus and ovaries.

“The assumption that testosterone has a negative effect on fertility or the fetus isn’t very well understood. For the most part, the misconception is that taking testosterone ruins someone’s fertility forever, but a lot of people have had success both after stopping HRT and getting pregnant accidentally while taking testosterone,” says Damien.

“Long-term effects are, so far, very under-researched. Not that the lack of research is exclusive to trans spaces, very few people are willing to allow trials and experiments to their unborn children, understandably.”

Studies have shown that it’s possible for TGNC individuals to get pregnant, even if they’ve been on testosterone for a long time. One individual even got pregnant after a decade of taking T.

This belief comes from how periods stop or lessen in intensity in many TGNC individuals who are on testosterone. The misconception has led to unplanned pregnancies.

“So, if folks want to avoid pregnancy while taking testosterone and have partners which could result in pregnancy, it is important to use contraception – all forms of contraception are safe and effective when taking testosterone but patients might have individual preferences based on their needs,” Kirkley says.

Birth control pills are feminizing hormone treatments, which many TGNC individuals anecdotally report counteracting the effects of masculinizing transition care.

There is little research on whether testosterone can affect your or the fetus’ health during pregnancy, so TGNC people who get pregnant while on T should talk to their doctor.

“Testosterone is technically a category X pregnancy medication due to possible impact on a fetus (based solely on animal research), so it is recommended to stop testosterone if somebody is trying to become pregnant or discovers that they are pregnant,” says Kirkley. Category X refers to a medication that’s contraindicated – or demonstrates some risk based on human or animal research – to pregnancy.

“However, there have been some case reports of babies being delivered in the context of a parent taking testosterone during a pregnancy, and no adverse effects were noted in the babies.”

Other research states that children may develop intersex traits as a result of testosterone. A study of cis women with polycystic ovarian syndrome, a condition that in part causes higher testosterone, found that testosterone blockers do not change the risk of adverse health outcomes. Additionally, testosterone blockers are not routinely prescribed to those with PCOS.

Many TGNC individuals report no health risks of being on testosterone while pregnant. As discussed in an article in The Conversation, it may do more harm than good for doctors to expect TGNC individuals to sacrifice their physical well-being for pregnancy, especially when there is no evidence of substantial harm.

“The potential negative mental health impact of stopping testosterone on the parent should always be acknowledged, and an individualized decision regarding testosterone use during pregnancy should be made acknowledging the known risks and benefits,” Kirkley continues.

When it comes to chestfeeding, there is also not much information available. What is known is that testosterone does not pass into chestmilk, but it may suppress milk production. 

Additionally, TGNC individuals can still chestfeed even after certain types of top surgery.

“It all depends on the type of surgery they have had, but yes, it can still be possible and should be discussed with one’s surgeon if that is a concern,” says Kirkley.

Individuals who have concerns about being able to chestfeed directly can use a chest supplementer, which allows the baby to get nutrients from an external source in conjunction with the physical act of chestfeeding.

Abortion

The process for getting an abortion is generally the same as it is for cisgender women, though medical bias can present a challenge. Misgendering is common, for example. While not all abortion providers misgender, a good portion do – enough that many advise to mentally prepare oneself.

Abortions put people in a vulnerable position. When mixed with misgendering or anti-trans discrimination, the experience becomes more difficult. According to one study, most TGNC people prefer getting their abortions through medication to avoid an uncomfortable invasion of privacy.

“I think seeking out an abortion is a challenge for most people, regardless of gender. Most clinics and doctors offices are willing to simply make a note about preferred pronouns and names,” says Damien. “Some doctors and nurses are good about it, some aren’t.”

“Abortions are a one-time procedure most of the time and don’t require a lot of follow-up if everything goes well, so at worst, you may simply have to grit your teeth through some misgendering for an afternoon.”

According to the 2022 U.S. Trans Survey, 24% of trans people avoided seeing doctors due to a fear of mistreatment. One study of transmasculine people of color found that there is a significant intersection between racism and transphobia and that medical practitioners often act with prejudice. Patients may need to choose their care with caution as practitioners may misgender patients, rely on racial stereotypes, ignore bodily diversity, and fail to give patients adequate information.

“When I think about those interactions that I’ve had, particularly at places where people have recommended.… And you go to those places… and it’s always something to imply that I’m hypersexual, that I’m a drug addict, or anything like that. That can only be my race… especially in LGBTQ center places… Because the space is so specifically centered on LGBTQ health, I think that’s where that level of disappointment really came in,” said one nonbinary Black latine participant of the study.

Many medical professionals also refuse to handle transgender care out of a lack of knowledge, leading to people being denied the care they need.

Individuals often turn to peers for a shoulder to lean on, but their communities have the same problems with queerphobia and racism as medical providers. Many are judgemental of or misgender TGNC people who get pregnant, treating them like they’re women and making them face the added discrimination of misogyny.

Peer support is still necessary, as it can help people to alleviate the trauma caused by abuse. This, coupled with supportive and knowledgeable medical professionals, can make all the difference in aiding the mental and physical health of TGNC individuals.

Sexual health

TGNC people remain under-researched when it comes to sexual health as well, including on the subject of HIV. But one thing that is known is that TGNC individuals face worrisome rates of HIV: 10 times that of the general population. While studies about risk may vary, seeking out testing and care like pre-exposure prophylaxis, or PReP, can be necessary.

Other barriers include financial costs and legal barriers. Treatments like cryopreservation IVFs, and surrogacy are notoriously expensive, with costs varying from $15,000, $20,000, and $200,000, respectively. In light of the fact that trans people face one of the highest poverty rates in the country, this can serve as an immense barrier to care.

“Trans people have trouble with legally changing their gender and still getting gender-specific care, such as trans men being denied pap smears. This is no less true for pregnancy and fertility-related issues,” says Damien.

“Many ‘women’s health’ clinics aren’t trans-friendly, and it’s a hard, scary thing to try to find care from someone you trust to be your doctor and also have them be covered by your insurance provider.”

What medical professionals can do

Doctors and other medical professionals have an easy solution to many of these problems: simply listening to their TGNC patients.

“Healthcare providers should not make assumptions about any patient’s gender identity, name, pronouns, titles, how they reference body parts, or any other component of their self or their care,” says Kirkley.

“Instead of assuming, we should make sure that we are asking and recording that information in our systems so that it is readily visible to all care team members.”

Additionally, Kirkley emphasizes hiring more TGNC workers, especially people of color. She says that this can revolutionize the care process for many patients.

Allies can follow these same strategies – listening and prioritizing the voices of TGNC individuals. Many TGNC people feel better when intrusive questions are avoided so that they can maintain some privacy.

“The most supportive thing anyone can do is just act normal. Be cool. Offer help if you can. Society has made a big thing out of trans people, and it’s getting brought up at every turn. But parenting is still parenting, and kids are still kids. Real support is found in the everyday moment, treating them like anyone else,” says Damien.

“Acting like something is out of place or needs extra attention, even if it’s well-meaning, is still annoying. Trans parents and potential parents just want to live their lives and have kids and parent them as best they can, just like anybody else. Letting it go like nothing is different is a better idea than drawing attention to it.”

A previous version of this article incorrectly spelled Dr. Jerrica Kirkley’s name. We regret the error.

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