Birth Control Options for Transgender and Non-Binary Individuals
Introduction
No matter where you are on the gender spectrum, you have the right to choose whether or not to use birth control if there is a possibility of pregnancy and you wish to prevent it. While not all transgender, non-binary, or gender expansive individuals choose to undergo gender affirming care, some opt for hormone therapy as part of their medical treatment to align their sexual characteristics with their gender identity. However, it’s important to note that gender-affirming hormone therapy is not designed to function as a contraceptive method. Therefore, it should not be relied upon solely for birth control purposes. Some individuals may also consider certain types of hormonal birth control for other reasons, such as managing gender dysphoria or reducing or stopping their menstrual periods.
Available Options
Birth control methods are not exclusive to any particular gender identity; they are accessible to everyone. The most suitable option for an individual depends on their specific circumstances, including their overall health, family planning goals, and tolerance for potential side effects. A healthcare professional can provide contraceptive counseling to help determine which option aligns best with an individual’s objectives. Communication and discussion between partners are also vital to ensure mutual understanding and agreement on birth control choices.
Trans Men and Non-Binary Individuals
For individuals taking testosterone (T) therapy to suppress feminine traits and develop masculine features, it’s important to note that while periods may stop, the possibility of pregnancy still exists. Therefore, it is advised that individuals who engage in vaginal sex with a partner who has ovaries and a uterus and does not want to become pregnant should use additional forms of birth control alongside testosterone therapy. If the goal is to conceive, it is necessary to discontinue testosterone therapy. Other hormone therapies, such as estradiol therapy for trans women and non-binary individuals, or those that suppress masculine traits, do not halt sperm production completely. Thus, it is crucial for individuals with testosterone therapy or these particular hormone therapies to use appropriate birth control methods to prevent unintended pregnancy.
Types of Birth Control
There are several birth control options available, and the most suitable choice varies from person to person. Factors that can influence decisions include ease of use, cost, potential side effects, individual misconceptions or beliefs, barriers to accessing birth control, and the quality of the relationship with healthcare providers. Some commonly used methods include:
- Condoms: Condoms not only provide protection against sexually transmitted infections (STIs) but also serve as a secondary form of birth control. However, it’s important to note that relying solely on condoms for contraception has a failure rate of approximately 13% due to inconsistent or incorrect use.
- IUDs: Intrauterine devices can provide highly effective long-term birth control. For transgender and non-binary individuals, certain types of IUDs release progestin, which does not cause feminizing effects. Non-hormonal copper IUDs are also available as an alternative.
- Progesterone-Only Methods: Progestin-based birth control options, such as some IUDs, implants, injections, or pills, can be considered. Progesterone-only methods may help alleviate or reduce vaginal bleeding.
- Combined Hormonal Contraceptives: These contraceptives, including patches, pills, and the vaginal ring, contain both estrogen and progestin. The amount of feminizing hormone in these contraceptives is not sufficient to affect testosterone therapy.
- Permanent Options: For individuals seeking a more permanent solution, vasectomy or tubal ligation can be performed. These procedures effectively prevent conception.
Seeking LGBTQ-Friendly Healthcare Providers
Many transgender and non-binary individuals have experienced discrimination or lack of respectful treatment in healthcare settings. To find LGBTQ-friendly providers, seeking recommendations from friends, family, or local LGBTQ organizations can be a helpful starting point. Some signs of LGBTQ-compliant providers may include visible non-discrimination policies, inclusive waiting rooms and bathrooms, intake forms that respect an individual’s gender identity, and providers who openly express their pronouns. However, it’s essential to remember that these indicators are not definitive proof of LGBTQ-friendliness, and individual experiences may still vary.
Conclusion
Access to contraception is a fundamental right for individuals of all gender identities. It is crucial for transgender and non-binary individuals to have accurate information about birth control options that align with their bodies, health goals, and personal circumstances. Open communication with healthcare providers and partners is key to effectively navigating and selecting the most suitable birth control method. By understanding and addressing the specific needs and concerns of transgender and non-binary individuals, healthcare professionals can contribute to providing inclusive and affirming care for all.
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No matter where you are on the gender spectrum, you can choose to use natality control if there is a possibility that you get pregnant and you don’t want to.
Not all the people who are Transgender, nonbinaryor gender expansive choose to get gender affirming care. But some people take hormone therapy as part of their medical care to help align their sexual characteristics with their gender identity. If you do, keep in mind that gender-affirming hormone therapy is not made for birth control, so you shouldn’t rely on it for that purpose.
Some people might also consider certain types of hormonal birth control for other reasons. For example, gender dysphoria – distress When your gender does not match the sex you were assigned at birth, it can get worse if you identify as male but were assigned female at birth and have your period. Some birth control options may decrease or stop your period.
Birth control is not designed for any particular gender identity. Anything that cisgender people can choose is available to everyone. The type of birth control that is best for you depends on your situation.
“If it’s a patient with no other risk factors, any option is available,” says Beth Cronin, MD, an obstetrician-gynecologist in Providence, Rhode Island. Things that may affect her decision include her health, family planning goals, and what side effects she is willing or able to live with.
Contraceptive counseling can help you decide which option best suits your goals, says Adam Bonnington, MD, an OB/GYN in San Francisco. (Contraceptive is another word for birth control.)
If your goal is to avoid pregnancy, you may want to consider birth control if:
- Have ovaries and a womb, you have not passed menopauseand you have vaginal sex with someone who has testicles and a penis.
- You have testicles and a penis, and you have vaginal sex with someone who has ovaries and a uterus who hasn’t gone through menopause and doesn’t want to get pregnant.
You and your partner may want to discuss what each of you wants and what your options are.
Trans men and non-binary people: If you take testosterone (T) therapy to curb the feminine traits and bring out the masculine ones, it will stop your periods. Some people assume that means they can’t get pregnant. But while pregnancy for someone in this situation is unlikely, it’s not impossible, Cronin says.
“We usually advise patients that if they take T and have that kind of sex, they could get pregnant and they should use birth control,” she says.
If you take testosterone as part of your gender affirmation care and you want to get pregnant, you will need to stop taking it.
Trans women and non-binary people: Some trans women and non-binary people take estradiol therapy as a feminizing hormone. That treatment will not work as birth control. Neither will hormone therapy that curbs masculine traits, because it doesn’t completely stop sperm production.
If you haven’t had a vasectomy (when a doctor cuts and seals the tubes that carry sperm) or orchiectomy (surgery to remove the testicles), and you have vaginal sex with your partner, make sure she uses birth control if she doesn’t want to get pregnant. You can also use a barrier method, such as a condom, but condoms don’t work as well as other forms of birth control.
Other types of hormone therapies that are not birth control methods include:
- cyproterone acetate
- finasteride
- Gonadotropin-releasing hormone (GnRH) analogues
There are several types of birth control. The right type for you might not be for someone else.
Things that can affect your decisions include:
- how easy it is to use
- Cost
- Possible side effects
- Misconceptions you have about it
- Things that make it hard to get birth control
- Discrimination or bias
- Your relationship with your doctor
Talk to your doctor if you have questions about your options.
condoms
Condoms will help protect you from sexually transmitted diseases (STDs). But to prevent pregnancy, you must also use another form of birth control.
If condoms are the only form of birth control you use, and you use them perfectly every time you have vaginal intercourse, there is a 2% chance that you will get pregnant. But most people don’t always use them correctly, bringing the chances of getting pregnant to about 13% if you’re not using a second form of birth control.
IUD
Intrauterine devices (IUDs) they are shaped like a T. A doctor inserts an IUD into the uterus for highly effective long-term birth control. It’s a quick process, but you’ll want to make sure you’re comfortable with it.
There are 5 types of IUDs approved in the US. Four of them release very small amounts of the hormone progestin, which will not cause any feminizing effect. The fifth type is a non-hormonal copper intrauterine device (you may hear them called a Cu-IUD).
Side effects can include vaginal spotting (where there is only a little blood) and bleeding. Some people also get electric shock related to your IUD. But most people stick with IUDs, according to a 2021 study published in the Journal of Midwifery and Women’s Health. That study was based on a survey of 105 trans men and gender diverse people with IUDs who had been assigned a female at birth. The IUDs were “well tolerated,” the researchers wrote, and few people sought removal because of side effects.
Progesterone-Only Methods
Progesterone is a hormone that your body makes. Progestin is a synthetic version of it.
Progesterone-only methods of birth control include some IUDs (levonorgestrel intrauterine systems), implants, injections or pills. Talk to your doctor about it first.
Shots or IUDs may help stop or slow bleeding from the vagina. To avoid bleeding, you may want to choose a method like the progestin-only implant, IUD, or injection, Bonnington says.
Combined hormonal contraceptives (CHCs)
Combined hormonal contraceptives (CHCs) include patches, pills, and the vaginal ring. They contain estrogen and progestin. There is not enough feminizing hormone in these contraceptives to affect testosterone therapy.
if you have had top surgery (surgery to remove breast tissue to create a more masculine chest), estrogen medications, such as birth control pills, patches, or the ring, can make your breasts feel tender or sore. “Some people notice some swelling 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 one can have a vasectomy or tubal ligation (surgery to cut, tie, or block the fallopian tubes). Both procedures will help prevent conception.
Many transgender and non-binary people say they have been discriminated against or not treated with respect in healthcare settings.
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 people to, Bonnington says.
Signs that the provider is LGBTQ compliant may include:
- A sign posted with non-discrimination policies that include gender identity and expression protections.
- A waiting room with brochures, magazines, or educational posters about transgender health.
- A bathroom labeled for use by all genders
- Intake forms requesting your correct name, pronouns, gender identity, and sex assigned at birth
- Providers who have their pronouns on their identification cards
Still, he says, these are not guarantees that a provider or clinic is LGBTQ-friendly.
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