Reproductive Autonomy for Transfeminine Individuals

According to Merriam-Webster, transfeminine people are whose gender identity is partially or fully feminine and differs from the sex the person had or was identified as having at birth; they are are people who were assigned male at birth (AMAB) but identify more with a feminine identity. 

Despite increasing awareness of LGBTQIA+ issues, research around the health, particularly reproductive health, needs of trans and nonbinary people has remained understudied despite their unique needs and challenges. The current mix of methods of contraceptive options primarily targets people with uteruses, meaning most of the responsibility for avoiding an unplanned pregnancy falls on people with uteruses.

Cisgender women receive the majority of focus when it comes to the research into, and conversations around, birth control options. Nonbinary and transgender people are often left out of the greater conversation around sexual and reproductive health, including contraception.

Transgender people are more likely to avoid preventative health care and medical appointments than their cisgender counterparts, due in part to issues of healthcare bias or lack of access to a trans-inclusive healthcare provider. This could also be due to the fear of discrimination, insurance issues, access, cost, or other issues.

Simply put, contraception beyond the gender binary needs to be included in research and education. Until everyone on the gender spectrum is included, healthcare providers will continue failing gender-diverse people.

LGBTQIA+ Awareness
Typically, society views sexual and reproductive health (SRH) services through a heteronormative gender binary lens, where protecting cisgender women from unintended pregnancies is the main focus. 

However, society's binary- and ciswomen-focused view of SRH has ignored the needs of people across the gender spectrum. This furthers the marginalization of already highly marginalized groups.

(To learn more about the intricacies and barriers nonbinary and transgender individuals experience in healthcare, read this detailed article: Beyond the Binary: Sexual and Reproductive Health Considerations for Transgender and Gender Expansive Adolescents.)

There is a lack of awareness and sex education about LGBTQIA+ people and methods of birth control or general reproductive health. This means many people in this community have to fend for themselves or rely on potentially dangerous information.

For example, a common misconception is that gender-affirming hormones can serve as an effective method to prevent pregnancy for everyone. However, transfeminine people who produce sperm are still at risk of causing an unintended pregnancy with their partner if they rely on these methods.

Take It From An Expert
Dr. Frances Grimstad is an attending physician at Boston Children's Hospital in the Division of Gynecology. She has been an advocate for trans reproductive health since her adolescence and she is now a researcher, clinician, and pediatric gynecologist specializing in gender-diverse patients.

MCI recently discussed the potential impact Non-Hormonal Reversible Male Contraception (NHRMC) could have on trans people with Dr. Frances Grimstad and she stated, "If you think about trans people, who are born with testes and a penis who are engaging in sex with people with a uterus, there's a chance they could have an unintended pregnancy. Also, patients who were born with a uterus and are transitioning who have partners that can get them pregnant. In all of those spaces, it is no longer the onus of the person with the uterus to think about contraception. Being able to have the option to utilize contraception and not have to think about it with your partner is amazingly empowering for patients who were born with testes and utilize things like estrogen. From my understanding, it doesn't appear that the physiology of reversible male contraception interacts significantly with feminizing hormone therapy. It's another way for people to be protected in their relationships and feel self-empowered."

Every body is unique and varied. For those undertaking the gender-affirming process, the need for a diverse range of contraception is vital to achieving their reproductive autonomy.

Reproductive Autonomy
Everyone on the gender spectrum deserves to have reproductive autonomy. We are working towards a world where everyone has access to sexual and reproductive health products and, therefore, more control over their family planning goals.

Researchers and healthcare providers need to dedicate more resources to understanding the reproductive health needs of all types of sperm producers.

More people are becoming aware of their authentic gender identity, potentially because of increased representation and gender education, despite the limited gender education in sex-ed class. Whatever the cause, there is an influx of gender-diverse patients for reproductive healthcare providers to consider and care for. 

These reproductive healthcare providers are challenged with navigating the current contraceptive landscape alongside their transitioning patients. For example, avoiding hormonal birth control pills is recommended while a transfeminine person takes gender-affirming hormones. This leaves external condoms and vasectomy as the only two methods of contraception available.

Ideally, an effective contraception method addresses each user's specific needs. Non-hormonal reversible male contraception (NHRMC) can serve people that are both taking gender-affirming hormones and are concerned about causing unintended pregnancies. In turn, this offers more freedom to choose the best option for themselves and their partner or partners..

MCI Raising Awareness
While the field of contraception and reproductive health is evolving, there is still a need to raise awareness. Healthcare has a vital need to improve inclusive language, education, and research for gender-diverse people. We can and must do better to ensure that healthcare, including contraception, is as inclusive as possible! Male Contraceptive Initiative wants to be part of this evolution.

For those who want to learn more about the LGBTQIA+ community, terms, or how you can help, visit Human Rights Campaign. The more you know, the better ally you can be!

MCI is working to address our reliance on cisgender and heteronormative language. While change can sometimes be a slow and daunting process, continuing to exclude entire groups of people is not acceptable.

This blog series results from our team's initial efforts to align our mission with our language and advocacy. We want to embrace and communicate the need for more significant changes in our professional community.

We are working towards doing better for all the transgender, nonbinary, gender non-conforming, intersex, and gender-fluid people. We are introducing a series of posts discussing how contraception affects people across the gender and sexuality spectrum.

We encourage you to reach out to us with any suggestions regarding our content. Please share a topic, resources, or individuals you think we should know about. Together we can achieve the positive change the world needs in order to be more inclusive of all people.

Nuts & Bolts: Transfeminine