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

May 8, 2021 Kar-Bay-Inc 1 Comment

No matter where you are on the gender spectrum — whether you’re transgender (trans), nonbinary, genderqueer, or gender nonconforming — you might need birth control, especially if there’s a chance you could get pregnant and you aren’t trying to.

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 you might take birth control (you might hear it called contraception). For example, gender dysphoria — the feeling when your gender doesn’t match the sex you were assigned at birth — can get worse if you’re nonbinary or a trans man and you start your period. Some birth control options can lessen or stop your period.

All options for birth control that cisgender people use are available for nonbinary and trans people. Still, some are better than others, depending on other medications you might be taking.

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

That’s where contraceptive counseling can help.

If you want to avoid pregnancy, contraceptive counseling can help 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 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 trans men and women and nonbinary people who have vaginal sex and don’t want to get pregnant.

Transmasculine people

If you’re a transgender man or nonbinary, you have vaginal sex and haven’t had a hysterectomy or a bilateral oophorectomy (where the doctor removes your fallopian tubes and ovaries), you should use birth control. Testosterone therapy (T) — a treatment that curbs feminine characteristics and brings out masculine ones — doesn’t 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, Cronin says. “We generally counsel patients that if they’re on T and are having that type of sex, they could get pregnant and they should be using contraception.”

If you’re transmasculine, taking testosterone and you want to get pregnant, you’ll have to stop taking it.

Transfeminine people

Some transgender women or nonbinary people get estradiol therapy — a treatment that brings on 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’re having vaginal sex. Neither will hormonal therapy, because it doesn’t completely stop the sperm you produce.

Types of hormonal therapies that aren’t birth control methods include:

Cyproterone acetate
Finasteride
Gonadotrophin releasing hormone (GnRH) analogues

If you haven’t had a vasectomy (when a doctor cuts and seals the tubes that carry sperm) or orchidectomy (when a doctor removes your testicles), make sure your partner uses birth control if you have vaginal sex and don’t want to get pregnant.

Birth Control Types and How to Use Them

How you’ll use the birth control depends on the method you and your partner choose.

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

Things that can affect your decisions include:

How easy it is to use
How much it costs
Possible side effects
Misconceptions you have about it
Things that make it hard to get birth control
Discrimination
Your relationship with your doctor

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

Condoms

Condoms are a popular form of birth control, but they’re not 100% effective in preventing pregnancy. If you do use condoms, know there’s a chance you or your partner could still get pregnant. If you use them the right way every time, there’s a 2% chance they could 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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IUDs

Another option is nonhormonal copper intrauterine devices (you might hear them called Cu-IUDs). These are completely safe to use and won’t interact with any hormone treatments you might get if you’re nonbinary or a trans man. But there could be side effects you don’t want, like vaginal spotting (where there’s only a little bit of blood) and bleeding.

Progestogen-only methods

If you want to use progestogen-only methods of birth control — like levonorgestrel intrauterine systems (IUS), implants, injections, or pills — talk to your doctor about it first. Some doctors don’t think it’ll affect the hormone treatments you might get if you’re trans or nonbinary, but others don’t recommend it.

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

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Injections or IUS could help you stop or lessen bleeding from your vagina.

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

Combined hormonal contraceptives (CHCs)

Transgender men and nonbinary people on testosterone treatment shouldn’t use combined hormonal contraceptives (CHC) — patches, pills, or the vaginal ring — that have estrogen and progestogen. That’s because CHC has estrogen, which can potentially interfere with the testosterone.

If you’ve had top surgery (where a surgeon removes breast tissue to create a more masculine chest), medications with estrogen, like birth control pills, patches, or the ring, can cause breast tenderness or soreness. “Some people note some 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 can get 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

About 56% of lesbian, gay, or bisexual individuals and 70% of transgender people say they experienced discrimination while seeking health care, according to one recent study.

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 they refer their patients to, Bonnington adds.

Signs the provider is LGBTQ-friendly include:

A clearly posted sign with nondiscrimination policies that include gender identity and expression protections
A waiting room with educational brochures, magazines, or posters about transgender health
Bathrooms labeled for all-gender use
Intake forms that ask for your correct name, pronouns, gender identity, and sex assigned at birth
Providers that have their pronouns on their name badges

Still, he says, these aren’t guarantees that a provider or clinic is LGBTQ-friendly.

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