Modern hormonal and prescription contraception is primarily focused on giving cisgender women, or people who identify as women who were also assigned female at birth, the means to protect themselves against an unintended pregnancy. While pills, patches, and IUDs are useful tools to help cis women control their fertility, they may fall short at protecting some cis men, trans, nonbinary, and intersex people. In recent years, there has been an increased awareness of sexual and reproductive health disparities adversely affecting LGBTQ populations.
More specifically, transmasculine people, who are men, male, nonbinary, or another gender identity different from their female sex assigned at birth, experience a range of complex social challenges when accessing reproductive health services, like contraception. There is a common misconception that taking testosterone can serve as a birth control option for trans men. However, transmasculine people are still at risk of an unintended pregnancy while receiving hormone therapy. In addition, there is little research on which contraceptive methods may be best for those who transition including those who take testosterone.
The shortcomings of our healthcare system have become more apparent as gender and sexuality continue to develop in today’s society. There is also a lack of research and understanding from clinicians about how to address the family planning needs of transmasculine people.
How can we create an environment that ensures that all people have the ability to control their reproductive outcomes?
As society’s relationship with gender and sexuality evolves, the way that we think about preventative healthcare services should evolve as well. In order for health care to better serve transmasculine people, it is important to prioritize individualization of care to cater to the needs of each client.
In addition to creating care plans that are tailored to each individuals’ specific needs, the healthcare system must address the physical barriers to obtaining contraceptive counseling. Place yourself in the shoes of a trans or nonbinary person. Imagine how you would feel if you walked into a clinic to talk to your provider about contraception and the receptionist makes assumptions about your visit based on your outward appearance. When you finally get a chance to speak to your provider, they call you by the wrong name/pronouns and have little information to help you control your reproduction. Something as simple as addressing someone by their correct name and pronouns goes a long way when caring for someone who is trans or gender nonconforming.
The challenge is that society, up until now, has looked at health care, sexuality, and reproduction through a binary lens. Fertility services and contraceptive options have mostly been geared towards helping (cis) women prevent instances of unintended pregnancy or plan future pregnancies. If cis men lack the resources to meaningfully contribute to family planning goals due to limited methods, what chance does anybody else have? If the healthcare system can find ways to de-gender health services and contraception, then reproductive health services will become more accessible to not only cis men, but also trans, intersex, and nonbinary individuals.
We interviewed Dr. Wilson Beckham, Assistant Scientist at Johns Hopkins Bloomberg School of Public Health, where he teaches LGBTQ health and researches trans health, HIV, and sexual and reproductive health. Dr. Beckham identifies as a queer transgender man and was kind enough to share his thoughts and experiences around LGBTQ reproductive health:
“After I came out as trans, my big reproductive health concerns were [avoiding pregnancy], stopping menstruation, and using a birth control form that didn’t make me feel dysphoric...I think a lot of people make the assumption that transmasculine people take testosterone and that it must be birth control, but it’s not a reliable form of birth control. I think more doctors are talking to their trans patients about that and are recommending methods of birth control if patients are sexually active with sperm producers.”
We also spoke with Roger Chapman, a member of the Board of Directors from the National LGBT Help Center. Roger identifies as a cis gay man and shared his experience with contraception in his relationships:
“I’ve had partners who were assigned female at birth in the past and we practiced safe sex with condoms. I’ve also had partners in the past who were trans men that had surgery to remove their internal reproductive organs and that eliminated any chance at a potential pregnancy. The surgery mitigated the hormones produced by their own body which alleviated any concerns they had about their gender identity. One of my sexual partners had an IUD implanted as an extra layer of protection.”
While Roger and his partners’ experiences demonstrate that there are ways to manage fertility using existing methods and interventions, the options are far from ideal. There is a clear need for novel, modern contraceptive products that work for bodies beyond cis women’s. Such products aren’t as far-fetched as you might think. In fact, there are multiple non-hormonal product leads that can be used by either men or women, including work in progress at YourChoice Therapeutics.
Dr. Beckham notes that despite such exciting advancements in the field of contraception and HIV prevention, including multi-purpose prevention technologies, LGBTQ individuals continue to be overlooked when it comes to clinical trials:
“There are interesting developments with vaginal rings for HIV prevention and various forms of birth control that can serve as multipurpose technologies. However, in that field transmasculine people have been ignored. There are no trans men in the trials for vaginal rings or in the trials for multipurpose technologies and I think there’s a lot of potential there. Having doctors realize that some transmasculine people do have sex with people with penises and are at risk of pregnancy. It's important for providers to be able to discuss what technologies are appropriate for their patients’ contraceptive needs.”
It’s clear that if we are to truly achieve the goal of “Reproductive Autonomy for All”, we must begin to shift our perspectives now to ensure greater emphasis on gender inclusivity in product development and clinical trial efforts.