Can You Get Pregnant on Testosterone?

Technically, there is always a risk of pregnancy if you have not had a hysterectomy. However, you should not be able to get pregnant on testosterone therapy. If your cycle has completely stopped (not just the monthly menstruation, but the ovulation part as well), and your testosterone levels are closely monitored and you have found your ideal dose, then there should not be a risk of pregnancy.

However, there is always a small chance of escape ovulation happening, even in someone who does not menstruate anymore and has been on testosterone therapy for a number of years. So if you have cause to believe you might be pregnant as a transgender man, then it is best to consult with healthcare providers urgently.

If you are indeed pregnant and want to continue with the pregnancy, you will need to stop testosterone therapy immediately.

In this article, we are going to look at options related to both individuals who are concerned about wanting to become pregnant and those who do not want to become pregnant.

Hormone Replacement Therapy

We have to remember that hormone therapy is essentially something that is often given to cisgender people as well, for various medical reasons. It is also, by now, not something that is new in the treatment of gender dysphoria. Hormone treatments, among all their other applications, can serve as agents to fertility but also as birth control measures.

Trans women and trans men have been able to receive hormone replacement therapy from a relatively young age for many years now, so there has been quite a bit of opportunity for the medical community to study its effects and its effectiveness.

We know that, in order for a person to fall pregnant, a number of factors need to line up. It is difficult, even for a cisgender woman to fall pregnant if her hormones are out of balance, or she does not menstruate for some other medical reason. However, unless a hysterectomy has been performed it is reckless to say that pregnancy is not possible.

It is safest to assume that if you are having vaginal sex with someone who has a penis (whether you are transgender people or not) then there could always, potentially, be some kind of risk of pregnancy. But, having said that, it is extremely unlikely for someone actively receiving hormone therapy in the form of testosterone use to fall pregnant naturally.

Future Fertility on Testosterone Therapy

If you are wanting to transition from an assigned female at birth to a trans man, and you do, at some point in the future, want to carry your own baby, you will need to discuss this with your healthcare providers. There is a possibility that testosterone therapy can influence your fertility in the future, but it is not a deal-breaker for future pregnancy.

It is also likely that you will need to stop testosterone therapy in order to get pregnant and carry to term.

While some transgender people will want to have children in the future, there will also be some who do not want children. This is a very personal choice for anyone to make. But if you find that at the moment you do not want to fall pregnant and you have cause to believe that there is a risk of it, it is best to discuss this openly with your doctor. Appropriate birth control will be available to you one way or another and there are options available that can be used in conjunction with testosterone use that is not hormonal in nature and will therefore not interfere with your hormone regimen.

Transgender Health

The underpinning of transgender health is gender identity and any gender dysphoria that needs to be addressed, either through hormone treatments or gender-affirming surgery, or most likely a combination of both. However, this is really not nearly the extent of it.

Gender dysphoria often occurs in conjunction with a mental health disorder of some kind. In fact, generally speaking, mental health disorders are far more prevalent in the general population now than it has ever been. However, the LGBTQ+ community is particularly vulnerable to emotional disorders simply because of the fact that they are so often victims of ridicule. They also tend to struggle more socioeconomically because they are often underpaid and struggle to find employment due to discrimination.

Therefore it is important to ensure that transgender men have access to healthcare professionals and health services that can support them, either in the case of unintended pregnancies, or efforts related to fertility preservation.

It is essential for the purpose of transgender equality that stigma around pregnant trans men be addressed. Even transgender men who no longer experience dysphoria and are secure in their gender identity often delay getting pregnant because they are intimidated by the extreme degree of over feminization that accompanies pregnancy at every step of the way. And that has been proven to be a societal thing and does not really have much to do with healthcare itself.

In reality, pregnancy has become a marketing tool that has been twisted into an experience that is so overly feminized that even cisgender women sometimes find it alienating as very few of us truly identify with that degree of femininity.

Biological Children

Many people have a longing to have their own children biologically, which is completely natural and understandable, and in the modern age of medicine, it is completely possible and safe for a transgender man to get pregnant if he chooses.

Even with cases of gender-affirming care and some degree of medical transition taking place in the meantime, many will retain their female reproductive organs. Top surgeries are far more prevalent than bottom surgeries and many never undergo bottom surgeries because of the significant positive impact that top surgery has on their feelings of dysphoria.

Therefore, medically speaking, future pregnancies remain possible, along with vaginal delivery. The possibility of this should be discussed with trans men early on in their transition and should ideally be normalized.

However, we have a long way to go before the modern medical system is well prepared for pregnant trans men. Some specialized facilities exist within the US and other parts of the world, but they are rare and most will need to attend ‘women’s clinics’ during the course of their pregnancy which can be difficult.

There is still a lot of work to do in order to make transgender men feel welcome in the world of pregnancy.

Insurance Coverage

Society is by no means currently equipped for transgender pregnancy and this applies to multiple levels. One of these levels is insurance coverage. While medical care is available, healthcare providers are ill-equipped to deal with transgender pregnancy and many providers will only see one or two cases, if any, during the course of their practice.

Another major hurdle in medical care for transgender patients who wish to get pregnant is the question of medical insurance. Most companies just will not cover pregnancy for transgender men. Trans patients who do wish to fall pregnant and deliver their own biological child will often have to do so out of pocket, which many cannot afford.

This becomes even more of a massive expense when IVF is required due to a need for donor sperm. In the US many insurance companies do not even cover IVF treatments of cisgender women, let alone a transgender man who hopes to become pregnant.

Pregnant Women (as assigned at birth)

Even in cases where a woman who was assigned female at birth becomes pregnant, many find it extremely difficult to identify with the over-emphasized femininity of the pregnancy journey. There seems to be an almost obsessive emphasis on «womanhood», «motherhood», or the concept of being a «mom», which is something that not many cisgender women can reconcile with to such an extreme.

The reality is that the experience of pregnancy has been marketed as something so over the top that it is near dissociative for some people. Postpartum depression is rife and one has to wonder whether this is not partly due to the pressures that this over-marketed version of pregnancy has created for women to be prepared and perfect for the experience of pregnancy and giving birth.

One has to wonder as to the emotional impact that it can have when one goes from a relatively independent female position where you are expected to be successful and adult and driven, to having grown adults referring to you as «mommy» and baby talking to your stomach, sometimes only acknowledging you are an actual person as an afterthought. There is almost a sense that you are required to surrender the entire extent of your identity to the role of ‘motherhood’ as soon as people find out that you are pregnant.

This further begs the question of how such an experience would impact transgender men. Are we prepared for this?

Experienced Pregnancy as Transgender Men

In recent years there have been cases of transgender men falling pregnant, by choice, and giving birth to their own biological children. The prevalence of these cases has slowly been on the increase and this has bought to light some areas within transgender health that still requires attention and improvement.

Transgender men who have experienced pregnancy note that while parts of the experience was jarring in terms of the feminine expectation, the actual experience within the medical settings was far less gendered and the terminology used was mainly scientifically accurate more so than gendered.  Medical staff is supportive for the most part and eager to learn about the experience of pregnancy from the perspective of transgender men.

Seeking care initially is daunting because even medical staff have not always assisted transgender men and there is always a concern for prejudice. It is therefore important to find medical providers that, if they do not have experience, are not biased and are willing to learn and provide the best possible conscientious care to a pregnant trans man.

Doctors and their support staff will need to understand the significant differences between treating an assigned sex pregnancy and transgender men who are pregnant. There has to be an understanding of how hormonal therapy and prior testosterone use will impact gestation. How and when these treatments need to be discontinued and when they need to start again after delivery.

It is important for transgender men to make sure that they are prepared, as much as is possible, for the changes their bodies will go through. Again, this is also something that women who were born female struggle with during pregnancy as well. But especially for trans people who have a history of gender identity issues and issues related to their bodies, it is important to address concerns in advance as far as possible.

While there are many official support services available, it might also be beneficial to seek out social health support in a more private capacity, such as through a private Facebook group, or something similar where you can engage with other trans men who might have already experienced pregnancy or those who want to and are experiencing the same concerns as yourself. Peer engagement can be extremely helpful. Also, remember that you will be stopping testosterone therapy for the duration of a pregnancy which can have its own set of effects on your body.

Finding the Right Doctor

Most doctors, if they do not understand pregnancy in transgender men already, will be able to research it thoroughly or to contact colleagues who have more experience. It is therefore important to remember that even if you do not have access to a specialist, there is still a way forward. What is perhaps most important is finding a doctor who will support and grow with you through the journey if you cannot find an expert. It could potentially pave the way for other transgender men in your area in the future.

There are so many significant differences even within common medical care that most doctors are quite adaptable.

Reproductive Options for Trans Women

As for trans men, there are biological reproductive options available for transgender women as well. The mechanics might very well depend largely on the nature of your intimate relationship and the biological sex of your partner, but generally speaking, as long as you are still fertile, and still have the necessary reproductive organs to facilitate either penetrative sex or a sperm donation, there is a reproduction option for you.

We need to remember that even cisgender heterosexual couples can, and do, struggle immensely with fertility, it is not at all as rare as we would like to think. Even sexual orientation has not been an immediate fertility factor for quite some time. Although the main emphasis has been on biological sex in the past, we can now clearly see that there is a need for a shift away from that.

The position that modern medicine is in right now should really mean that trans people should not have difficulty with fertility-related matters simply because there are so many options and medicine is evolving almost daily.

For the most part, the biggest obstacles that trans people will face are social in nature.

Social Issues with Reproduction in Transgender Individuals

There is no denying that bias and prejudice are still major issues within today’s society. We are still, in a way, held captive by social expectations attributed to our reproductive organs more so than our actual gender identity. This makes it extremely difficult for transgender individuals who want to become parents, through any means available.

Furthermore, trans men also still run the risk of developing postpartum depression, which is actually a normal risk for all people experiencing pregnancy. This would mean yet another health services provider who needs to be available to treat a trans guy. Postpartum depression is often treated by both a psychologist (who provides counseling), and a medical professional who can prescribe medications if needed. This is a condition that should never be left untreated.

An Ideal Future

Ideally, in the future, pregnancy and reproduction will become as natural for transgender people as it is for cisgender people. We will have a more in-depth understanding of the effects of prior testosterone use, and the impact of other hormonal therapies on pregnancies and fertility in transgender men.

Perhaps still further in the future, we will have started to experiment with more options for a transgender woman as well. There have been recent strides made in the science of uterus transplants for cisgender women. Is this a possible future endeavor in transgender health?

What other options might the future hold?

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