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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Vydáno v:	American journal of obstetrics and gynecology Ročník 222; číslo 2; s. 134 - 143
Hlavní autoři:	Krempasky, Chance, Harris, Miles, Abern, Lauren, Grimstad, Frances
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	United States Elsevier Inc 01.02.2020
Témata:	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 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
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 – sequence: 4 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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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
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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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