Birth Control: Types and Considerations for Transgender and Nonbinary People

No matter wherever you are connected nan gender spectrum, you mightiness take to usage birth control if there’s a chance you could get pregnant and you don’t want to.

Not each group who are transgender, nonbinary, aliases gender expansive take to get gender-affirming care. But immoderate group do return hormone therapy arsenic portion of their aesculapian attraction to thief align their activity characteristics pinch their gender identity. If you do, support successful mind that gender-affirming hormone therapy isn’t made for commencement control, truthful you shouldn’t trust connected it for that purpose. 

Some group mightiness besides see definite types of hormonal commencement power for different reasons. For example, gender dysphoria – distress erstwhile your gender doesn’t lucifer nan activity assigned to you astatine commencement – tin get worse if you place arsenic antheral but were assigned female astatine commencement and get your period. Some commencement power options tin lessen aliases stop your period.

Birth power is not designed for immoderate peculiar gender identity. Anything that cisgender group mightiness take is disposable for everyone. The type of contraceptive that’s champion for you depends connected your situation. 

“If it’s for a diligent pinch nary different consequence factors, immoderate action is available,” says Beth Cronin, MD, an obstetrician-gynecologist successful Providence, RI. Things that whitethorn impact your determination see your health, family readying goals, and what broadside effects you’re consenting aliases capable to unrecorded with.

Contraceptive counseling tin thief you determine which action champion matches your goals, says Adam Bonnington, MD, an obstetrician-gynecologist successful San Francisco. (Contraceptive is different connection for commencement control.)

If your extremity is to debar pregnancy, you whitethorn want to see commencement power if:

• You person ovaries and a uterus, you person not gone done menopause, and you person vaginal activity pinch personification who has testicles and a penis. 
• You person testicles and a penis, and you person vaginal activity pinch personification who has ovaries and a uterus who hasn’t been done menopause and doesn’t want to get pregnant.

You and your partner whitethorn want to talk what you each want and what nan options are.

Trans men and nonbinary people: If you return testosterone therapy (T) to curb feminine traits and bring retired masculine ones, it will extremity your periods. Some group presume that intends they can’t get pregnant. But while a gestation for personification successful this business is unlikely, it’s not impossible, Cronin says.

“We mostly counsel patients that if they’re connected T and are having that type of sex, they could get pregnant and they should beryllium utilizing contraception,” she says. 

If you return testosterone arsenic portion of your gender-affirming care, and you want to get pregnant, you’ll person to extremity taking it.

Trans women and nonbinary people: Some trans women and nonbinary group return estradiol therapy arsenic a feminizing hormone. That curen won’t activity arsenic commencement control. Neither will hormonal therapy that curbs masculine traits, because it doesn’t wholly extremity sperm production.

If you haven’t had a vasectomy (when a expert cuts and seals nan tubes that transportation sperm) aliases orchiectomy (surgery to region nan testicles), and you person vaginal activity pinch your partner, make judge they usage commencement power if they don’t want to get pregnant. You tin besides usage a obstruction method, specified arsenic a condom, but condoms do not activity arsenic good arsenic different forms of commencement control.

Other types of hormonal therapies that aren’t commencement power methods include:

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

There are respective types of commencement control. The type that’s correct for you mightiness not beryllium correct for personification else. 

Things that tin impact your decisions include:

• How easy it is to use
• Cost
• Possible broadside effects
• Misconceptions you person astir it
• Things that make it difficult to get commencement control
• Discrimination aliases bias
• Your narration pinch your doctor

Talk to your expert if you person questions astir your options.

Condoms

Condoms will thief protect you from sexually transmitted diseases (STDs). But to debar pregnancy, you should besides usage different shape of commencement control.

If condoms are nan only shape of contraception you usage – and you usage them perfectly, each clip you person vaginal activity – there’s astir a 2% chance that you could get pregnant. But astir group don’t ever usage them correctly, driving up nan likelihood of getting pregnant to astir 13% if you’re not utilizing a 2nd shape of contraception. 

IUDs

Intrauterine devices (IUDs) are shaped for illustration a T. A expert inserts an IUD into your uterus for long-term, highly effective contraception. It’s a speedy process, but you’ll want to make judge you’re comfortable pinch that.

There are 5 types of IUDs approved successful nan U.S. Four of them merchandise very mini amounts of nan hormone progestin, which will not origin immoderate feminizing effects. The 5th type is simply a nonhormonal copper intrauterine instrumentality (you mightiness perceive these called Cu-IUDs). 

Side effects tin see vaginal spotting (where there’s only a small spot of blood) and bleeding. Some group besides get cramps related to their IUD. But astir group instrumentality pinch nan IUDs, according to a 2021 study published successful nan Journal of Midwifery and Women’s Health. That study was based connected a study of 105 trans men and gender divers group pinch IUDs who had been assigned female astatine birth. The IUDs were “well tolerated,” nan researchers wrote, pinch fewer group seeking to region them because of broadside effects. 

Progesterone-only methods

Progesterone is simply a hormone that your assemblage makes. Progestin is simply a synthetic type of it. 

Progesterone-only methods of commencement power see immoderate IUDs (levonorgestrel intrauterine systems), implants, shots, aliases pills. Talk to your expert astir it first. 

Shots aliases IUDs could thief you extremity aliases lessen bleeding from your vagina. To debar bleeding, you whitethorn want to take a method for illustration nan progestin-only implant, IUD, aliases shot, Bonnington says.

Combined hormonal contraceptives (CHCs)

Combined hormonal contraceptives (CHCs) see patches, pills, and nan vaginal ring. They incorporate estrogen and progestogen. There isn’t capable feminizing hormone successful these contraceptives to impact testosterone therapy.

If you’ve had top surgery (surgery to region bosom insubstantial to create a much masculine chest), medications pinch estrogen – specified arsenic commencement power pills, patches, aliases nan ringing – mightiness make your breasts consciousness tender aliases sore. “Some group statement immoderate bloating and things for illustration that, but it’s really going to dangle connected nan person,” Cronin says.

More imperishable options

There are besides much imperishable forms of commencement control. Either partner tin get a vasectomy aliases tubal ligation (surgery to cut, tie, aliases artifact nan fallopian tubes). Both procedures will thief forestall conception.

Many transgender and nonbinary group opportunity they’ve been discriminated against aliases different not treated respectfully successful wellness attraction settings.

Sometimes nan champion measurement to find LGBTQ-friendly providers is done connection of rima from family aliases friends, Cronin says. Local LGBTQ organizations often person a database of providers they mention group to, Bonnington says.

Signs nan supplier is LGBTQ-friendly tin include:

• A posted motion pinch nondiscrimination policies that see gender personality and look protections
• A waiting room pinch acquisition brochures, magazines, aliases posters astir transgender health
• A bath branded for all-gender use
• Intake forms that inquire for your correct name, pronouns, gender identity, and activity assigned astatine birth
• Providers who person their pronouns connected their sanction badges

Still, he says, these aren’t guarantees that a supplier aliases session is LGBTQ-friendly.