You are transgender or non-binary
Wondering if you need birth control?
Regardless of whether you identify as trans or non-binary, or relate to any other part of the gender spectrum, you might need birth control. Like for everybody else, it very much depends on your individual needs. Pregnancy can happen with vaginal sex if you have a uterus and ovaries, and your partner has a penis and testicles. So if you are having vaginal sex and you do not plan to get pregnant, you should consider birth control. All birth control options available to cis people are available to you.
Birth control on hormone treatment?
Short answer – yes! Because gender-affirming hormones (like testosterone) are not reliable as birth control. Better consult with your doctor first before going on a new birth control. Here are a few tips to get you started:
IF YOU ARE A TRANS MAN OR NON-BINARY
If you are a trans man or non-binary who has vaginal sex and has not had surgery to remove their uterus (hysterectomy) or ovaries (oophorectomy), or surgery to block the tubes that carry eggs to the uterus (tubal ligation), you should consider birth control.
Testosterone can limit estrogen production over time and stop your period within one to 12 months, but this is not enough to avoid pregnancy. Even if you have been taking testosterone for long, it is still possible to get pregnant. This is particularly important as testosterone can cause defects in an unborn child.
Which method is right?
As a trans man or non-binary person who is taking hormones, you can use all the birth control methods available to cis females. Having said that, it is not fully understood if estrogen-containing combined hormonal methods may or may not interfere with the masculinizing effects of testosterone. So you might prefer to consider these last if the other options are acceptable to you. Talk to your doctor about your birth control and fertility needs!
Reversible (barrier methods such as the male condom, the diaphragm, and the IUD) and irreversible (tubal ligation or surgery to remove sex organs)
The IUS, the implant, the injection, and the progestogen-only pill
The patch, the vaginal ring, and some pills also contain estrogen in addition to progestogen. It is not fully understood if estrogen may or may not interfere with the masculinizing effects of testosterone. So for those on testosterone treatment, you may prefer to consider non-estrogen methods first if they are acceptable to you.
If your partner is a trans woman
If you have vaginal sex with your partner, and they are a trans woman who has not had surgery to remove their penis (penectomy) or testicles (orchiectomy), or surgery to cut or block the tubes that carry sperm (vasectomy), you should consider birth control. Estrogen treatment in trans women who are transitioning does not completely stop sperm production, and none of the anti-androgenic treatments are effective as birth control.
FINDING A DOCTOR
Discussing your fertility needs with a doctor is an important step in your health and fertility planning. Choosing the right doctor, who is empathetic and understands your needs, can help smooth the process.
Tips for the appointment:
- Ask loved ones to join you.
- Communicate your pronouns and names for body parts.
- Consider potential physical examinations of the vagina, uterus or ovaries.
- Change your doctor if you don’t feel comfortable with them.
Ask around in your community of friends or check out the resources below to find a doctor:
World Professional Association for Transgender Health (WPATH)
I am on testosterone and don’t get my periods, do I still need birth control?
Although not having a period makes it unlikely to get pregnant, it is not impossible. You may still be ovulating with testosterone, and as long as you ovulate, there is a chance for pregnancy. So you should still consider birth control if you’re having vaginal sex.
Does stopping birth control return my fertility even if I am on testosterone?
Testosterone should not be relied on to prevent pregnancy. But if you are planning to get pregnant, you will be asked by your doctor to stop taking it, especially as it can cause defects in an unborn child. Always discuss your fertility needs and desires with your doctor first.
Will hormonal birth control reduce my clitoral size, make my breasts bigger, or slow down my transition?
These are usually not seen when sufficient testosterone doses are taken. But we are still learning about the combined effects of estrogen and testosterone, so you may prefer to consider non-estrogen birth control methods first if they are acceptable to you. Always discuss your concerns with your doctor and learn about your options.
Do I need birth control after gender-affirming surgery?
There are different types of gender-affirming surgery. Removing breast tissue won’t affect your fertility. But if you remove your uterus or ovaries, or undergo tubal ligation, you cannot get pregnant and you won’t need birth control.
Should I expect a Pap smear at my birth control and fertility counseling?
Trans men and non-binary people who have a vagina need to get a Pap smear, just like cis females. This is very important to screen for cervical cancer. It will not necessarily happen at your birth control and fertility counseling, but your doctor may advise that you get one as part of your regular health checkups depending on your age.
Does any birth control method affect long-term fertility when combined with hormone treatment?
Gender-affirming surgery that involves removal of the uterus and ovaries can permanently affect fertility. Gender-affirming hormone treatment also affects fertility, but this is usually reversible within months. The World Professional Association for Transgender Health advises family planning counseling before transitioning (even with hormones) to learn about all your options (such as freezing eggs). Remember, your fertility desires and options could change with age.
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