Contraception across the transmasculine spectrum

The field of transgender health continues to expand rapidly, including research in the area of family planning. While much attention has been given to fertility preservation and the parenting intentions of transgender individuals, far less has been paid to pregnancy prevention and contraceptive need...

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Published in:American journal of obstetrics and gynecology Vol. 222; no. 2; pp. 134 - 143
Main Authors: Krempasky, Chance, Harris, Miles, Abern, Lauren, Grimstad, Frances
Format: Journal Article
Language:English
Published: United States Elsevier Inc 01.02.2020
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ISSN:0002-9378, 1097-6868, 1097-6868
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Abstract The field of transgender health continues to expand rapidly, including research in the area of family planning. While much attention has been given to fertility preservation and the parenting intentions of transgender individuals, far less has been paid to pregnancy prevention and contraceptive needs of people along the transmasculine gender spectrum (transgender men and gender-nonbinary persons who were assigned female at birth). Existing research illustrates that many clinicians and transmasculine individuals falsely believe that there is no risk of pregnancy while amenorrheic. These studies also show inconsistent counseling practices provided to transmasculine persons surrounding contraception and pregnancy while falling short of providing robust clinical guidance for improvement. Clinicians report a lack of adequate training in transgender reproductive health, and consequently, many do not feel comfortable treating transgender patients. The aim of this publication is to consolidate the findings of these prior studies and build upon them to offer comprehensive clinical guidance for managing contraception in transmasculine patients. To do so, it reviews the physiologic effects of testosterone on the sex steroid axis and current understanding of why ovulation and pregnancy may still occur while amenorrheic. Gender-inclusive terminology and a suggested script for eliciting a gender-affirming sexual history are offered. Common concerns (such as the effects on gender dysphoria and gender affirmation) and side effects of available contraceptive methods are subsequently addressed and how these may have a unique impact on transmasculine persons as compared with cisgender women. Lastly, a model is provided for approaching contraceptive counseling in the transmasculine population to assist clinicians and patients in determining the need for and selection of the type of contraception. To center transmasculine voices, the development of this publication’s guidelines have been led by reproductive care clinicians of transgender experience.
AbstractList The field of transgender health continues to expand rapidly, including research in the area of family planning. While much attention has been given to fertility preservation and the parenting intentions of transgender individuals, far less has been paid to pregnancy prevention and contraceptive needs of people along the transmasculine gender spectrum (transgender men and gender-nonbinary persons who were assigned female at birth). Existing research illustrates that many clinicians and transmasculine individuals falsely believe that there is no risk of pregnancy while amenorrheic. These studies also show inconsistent counseling practices provided to transmasculine persons surrounding contraception and pregnancy while falling short of providing robust clinical guidance for improvement. Clinicians report a lack of adequate training in transgender reproductive health, and consequently, many do not feel comfortable treating transgender patients. The aim of this publication is to consolidate the findings of these prior studies and build upon them to offer comprehensive clinical guidance for managing contraception in transmasculine patients. To do so, it reviews the physiologic effects of testosterone on the sex steroid axis and current understanding of why ovulation and pregnancy may still occur while amenorrheic. Gender-inclusive terminology and a suggested script for eliciting a gender-affirming sexual history are offered. Common concerns (such as the effects on gender dysphoria and gender affirmation) and side effects of available contraceptive methods are subsequently addressed and how these may have a unique impact on transmasculine persons as compared with cisgender women. Lastly, a model is provided for approaching contraceptive counseling in the transmasculine population to assist clinicians and patients in determining the need for and selection of the type of contraception. To center transmasculine voices, the development of this publication's guidelines have been led by reproductive care clinicians of transgender experience.The field of transgender health continues to expand rapidly, including research in the area of family planning. While much attention has been given to fertility preservation and the parenting intentions of transgender individuals, far less has been paid to pregnancy prevention and contraceptive needs of people along the transmasculine gender spectrum (transgender men and gender-nonbinary persons who were assigned female at birth). Existing research illustrates that many clinicians and transmasculine individuals falsely believe that there is no risk of pregnancy while amenorrheic. These studies also show inconsistent counseling practices provided to transmasculine persons surrounding contraception and pregnancy while falling short of providing robust clinical guidance for improvement. Clinicians report a lack of adequate training in transgender reproductive health, and consequently, many do not feel comfortable treating transgender patients. The aim of this publication is to consolidate the findings of these prior studies and build upon them to offer comprehensive clinical guidance for managing contraception in transmasculine patients. To do so, it reviews the physiologic effects of testosterone on the sex steroid axis and current understanding of why ovulation and pregnancy may still occur while amenorrheic. Gender-inclusive terminology and a suggested script for eliciting a gender-affirming sexual history are offered. Common concerns (such as the effects on gender dysphoria and gender affirmation) and side effects of available contraceptive methods are subsequently addressed and how these may have a unique impact on transmasculine persons as compared with cisgender women. Lastly, a model is provided for approaching contraceptive counseling in the transmasculine population to assist clinicians and patients in determining the need for and selection of the type of contraception. To center transmasculine voices, the development of this publication's guidelines have been led by reproductive care clinicians of transgender experience.
The field of transgender health continues to expand rapidly, including research in the area of family planning. While much attention has been given to fertility preservation and the parenting intentions of transgender individuals, far less has been paid to pregnancy prevention and contraceptive needs of people along the transmasculine gender spectrum (transgender men and gender-nonbinary persons who were assigned female at birth). Existing research illustrates that many clinicians and transmasculine individuals falsely believe that there is no risk of pregnancy while amenorrheic. These studies also show inconsistent counseling practices provided to transmasculine persons surrounding contraception and pregnancy while falling short of providing robust clinical guidance for improvement. Clinicians report a lack of adequate training in transgender reproductive health, and consequently, many do not feel comfortable treating transgender patients. The aim of this publication is to consolidate the findings of these prior studies and build upon them to offer comprehensive clinical guidance for managing contraception in transmasculine patients. To do so, it reviews the physiologic effects of testosterone on the sex steroid axis and current understanding of why ovulation and pregnancy may still occur while amenorrheic. Gender-inclusive terminology and a suggested script for eliciting a gender-affirming sexual history are offered. Common concerns (such as the effects on gender dysphoria and gender affirmation) and side effects of available contraceptive methods are subsequently addressed and how these may have a unique impact on transmasculine persons as compared with cisgender women. Lastly, a model is provided for approaching contraceptive counseling in the transmasculine population to assist clinicians and patients in determining the need for and selection of the type of contraception. To center transmasculine voices, the development of this publication's guidelines have been led by reproductive care clinicians of transgender experience.
Author Krempasky, Chance
Grimstad, Frances
Abern, Lauren
Harris, Miles
Author_xml – sequence: 1
  givenname: Chance
  surname: Krempasky
  fullname: Krempasky, Chance
  organization: Callen-Lorde Community Health Center, New York, NY
– sequence: 2
  givenname: Miles
  surname: Harris
  fullname: Harris, Miles
  organization: One Community Health, Sacramento, CA
– sequence: 3
  givenname: Lauren
  surname: Abern
  fullname: Abern, Lauren
  organization: Care Resource, Miami, FL
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  givenname: Frances
  orcidid: 0000-0002-2442-724X
  surname: Grimstad
  fullname: Grimstad, Frances
  email: frances.grimstad@childrens.harvard.edu
  organization: Department of Surgery, Boston Children’s Hospital, Boston, MA
BackLink https://www.ncbi.nlm.nih.gov/pubmed/31394072$$D View this record in MEDLINE/PubMed
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Issue 2
Keywords gender affirming
sexual health
transmasculine
bisexual
gender nonbinary
transgender men
contraception
female to male
family planning
lesbian
and questioning (or queer)
vulnerable populations
gay
transgender
Language English
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Snippet The field of transgender health continues to expand rapidly, including research in the area of family planning. While much attention has been given to...
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elsevier
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StartPage 134
SubjectTerms and questioning (or queer)
Androgens - therapeutic use
bisexual
contraception
Contraception - methods
Contraceptive Agents, Hormonal
Contraceptive Devices
family planning
Female
female to male
gay
gender affirming
Gender Dysphoria
gender nonbinary
Humans
Intrauterine Devices, Copper
lesbian
Male
Medical History Taking
Pregnancy
Pregnancy, Unplanned
Sex Reassignment Procedures
sexual health
Sterilization, Reproductive
Terminology as Topic
Testosterone - therapeutic use
transgender men
Transgender Persons
transmasculine
vulnerable populations
Title Contraception across the transmasculine spectrum
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https://dx.doi.org/10.1016/j.ajog.2019.07.043
https://www.ncbi.nlm.nih.gov/pubmed/31394072
https://www.proquest.com/docview/2270003544
Volume 222
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