Contraception in Gender-Diverse Patients
Penny Wilson, MBBS, and Heidi James, MD
No matter their appearance, if someone with a uterus and ovaries is having vaginal sex with someone with a penis and testes, they could become pregnant. Penny Wilson joins us to review contraception for our transgender and gender-diverse patients.
- A thorough sexual history is important, including goals of treatment, the types of sex they’re having, and the type of genitals their sexual partner or partners have.
- Make no assumptions and enquire with curiosity.
- Male transgender patients
- These patients may have worsened dysphoria with cyclical bleeding and may desire suppression of bleeding (but not all patients will).
- Some may desire the option of future fertility.
- Patients may or may not be on masculinizing hormone therapy (eg, testosterone).
- Testosterone therapy
- Testosterone typically suppresses periods within 6 months or so but it is NOT reliable as a form of contraception.
- It has potentially harmful effects on fetuses, so avoidance of pregnancy is important.
- Options for contraception:
- All options are available.
- Typically, estrogen is avoided for people taking testosterone because it can interfere with their testosterone therapy.
- Progestin-only methods with high rates of amenorrhoea are a good option:
- Levonorgestrel intrauterine device (IUD) or Depo injection
- Other progestin-only methods can be used (eg, progestin-only pill) but breakthrough bleeding may be problematic
- Copper IUD is another option.
- Gender-affirming “bottom” or “lower half” surgery that removes the uterus may be an option for some.
- Gender-diverse patients who are assigned male at birth
- Gender-affirming hormone therapy with estrogen and anti-androgens will not reliably stop sperm production or suppress fertility.
- Options are the same as for cis men: condoms or vasectomy.
- Some also pursue bottom surgery, including orchiectomy.
PEARL: Be sure to address contraceptive needs with your transgender and gender-diverse patients.
REFERENCES:
Trans Care BC: http://www.phsa.ca/transcarebc/about/who-we-are
RELATED CONTENT:
Crunch Time FM LGBTQ+: Contraception
