What Happens If a Cisgender or Trans Man Takes Hormonal Birth Control?

It depends on who’s taking it and why.

Transgender men, who are assigned female at birth, might or might not have a uterus, ovaries, and a vagina.

This is because some transgender men have bottom surgery and other gender-confirming surgeries, while others do not.

Transgender men who take hormonal birth control will find that it affects them similarly to how it affects cisgender women.

Many transgender men undergo hormone therapy, which is when you’re given hormonal treatments (namely testosterone) to change your secondary sex characteristics.

This can cause you to grow facial hair and develop a deeper voice, for example.

Whether you’re on testosterone or not, hormonal birth control can be used to prevent pregnancy and to help with other reproductive issues, such as heavy periods.

For cisgender (that is, non-transgender) men, taking hormonal birth control is a little different.

If you accidentally take one or even a few pills, nothing is likely to happen. But if you keep taking contraceptives, it can cause some changes to your body over time.

Long-term use of estrogen-based contraception can cause the breast tissue to develop. It can affect your sex drive and fertility.

Let’s consider the definition of the word “man.” Many people think of men as having penises, and subsequently unable to become pregnant.

However, transgender men — who may have vaginas and may be able to become pregnant — are men.

Men — specifically transgender men — can actually get pregnant, even if they’re undergoing hormone therapy and taking testosterone.

Although testosterone can reduce the chances of becoming pregnant, it’s still possible to conceive on the medication.

This means that issues around reproductive health, like abortion and contraception, need to consider the needs of trans men (as well as nonbinary and gender-nonconforming people).

Many transgender men take hormonal birth control to avoid pregnancy.

You might also take contraceptives to manage hormone-related symptoms, or to avoid menstruating altogether.

If you’re a cisgender man who’s interested in contraception, hormonal birth control pills intended for people with uteruses won’t work for you. They won’t prevent pregnancy.

If you’re a transgender man, you can use hormonal birth control, regardless of whether you’re taking testosterone.

Hormonal birth control and testosterone can be used together.

Both will still be effective, and doing so shouldn’t produce any uncomfortable or harmful effects.

Options

If you’re a cisgender man, there are very few contraceptive options for you. While we still don’t have a birth control pill for cisgender men, you could opt for condoms or a vasectomy.

If you’re a transgender man, there are a number of birth control options for you. Whether they’ll work for you depends on your individual anatomy and biology.

You could consider birth control options like:

• birth control pills
• IUD
• implant
• sponge
• injection
• patch
• ring
• condoms (both internal and external)

No matter your gender, it’s important to discuss your contraceptive options with a knowledgeable doctor.

Side effects and other considerations

As with cisgender women, every form of birth control can have its own set of side effects and risks.

These side effects might be severe in some people and nonexistent in others.

For example, some people experience extreme cramps with an IUD while others have no cramps at all.

Many transgender men use progesterone-only birth control and avoid estrogen-based birth control, believing the estrogen would interfere with the testosterone or reduce its masculinizing effect.

However, there’s no data or anecdotal evidence to suggest that estrogen-based birth control affects the masculinization process.

Myths and misconceptions to be aware of

Myth: Transgender men can’t become pregnant when taking testosterone.

Fact: As long as you have ovaries and a uterus, you can become pregnant regardless of whether you’re taking testosterone. Testosterone isn’t a form of contraception.

Many transgender men use hormonal birth control to manage certain symptoms.

Just like cisgender women may use the pill to reduce hormonal acne, regulate periods, or reduce mood swings, trans men might use it for the same reasons.

For some, menstruation can trigger gender dysphoria.

Gender dysphoria is the distressing feeling that your gender identity doesn’t correlate to the sex you were assigned at birth or to the way you look.

Transgender men often look into using birth control to stop themselves from menstruating.

While testosterone can affect the menstrual cycle, many people still bleed from time to time while using testosterone. Hormonal birth control can help prevent that.

Options

The type of hormonal birth control you choose depends on the symptoms you’re trying to treat.

Certain hormonal birth control pills are often prescribed to treat acne, while others are used to treat heavy periods.

Bear in mind that you might be able to manage symptoms without using contraceptives.

If you want to manage certain symptoms that are often treated with contraceptives but you want to avoid hormonal birth control, talk to a doctor.

For example, if you’re trying to manage acne-prone skin, your doctor might be able to prescribe acne treatments, such as a topical cream, an antibiotic, or isotretinoin (Accutane).

If you’re hoping to stop yourself from menstruating, hormonal birth control pills used continuously — that is, without taking the placebo sugar pills — could help.

Side effects and other considerations

The side effects vary from person to person. They depend on the type of birth control you choose.

Hormonal birth control pills can lead to side effects like:

• nausea
• chest tenderness
• weight gain
• libido changes

Hormonal birth control pills aren’t suitable for some people, including people with high blood pressure, as it can increase the risk of forming blood clots.

For this reason, a doctor will take your blood pressure and ask about your medical history before prescribing any contraceptives.

Myths and misconceptions to be aware of

Myth: People on testosterone can’t menstruate.

Fact: Testosterone often makes your period less regular and more sparse, but many people who take testosterone still menstruate. Long-term use of testosterone usually stops menstruation.

Many transgender people undergo hormone therapy.

For example, people who are assigned male at birth but identify as something other than male might consider feminizing hormone therapy.

“Feminization” is the process of becoming more feminine-looking (or starting to feel more feminine) through medical treatments.

Feminizing medications include:

• estrogens, which reduce testosterone and produce feminizing secondary sex characteristics
• anti-androgens, which reduce the effects of masculinizing hormones on the body

Many people think that estrogen-based birth control will help with feminization, but it doesn’t exactly work that way.

The process of hormonal transitioning is complex. It requires specialized medication and the supervision of an expert.

Options

If you’re looking into feminizing treatment and hormone therapy, it’s essential to talk to a knowledgeable, trans-friendly doctor.

They’ll screen you to ensure that hormone therapy will be safe for you. They’ll explain the exact process of beginning hormone therapy.

Side effects and other considerations

According to Mayo Clinic, there are a few potential side effects of feminizing hormone therapy.

They can range in severity from person to person and may include:

• weight gain
• decreased libido
• erectile dysfunction
• gallstones
• high triglycerides, which is a type of fat in your blood
• high blood pressure
• blood clots
• type 2 diabetes
• cardiovascular disease
• infertility

Hormone therapy can be riskier for people with certain conditions, such as people with a history of hormone-sensitive cancer (like prostate cancer) or high blood pressure.

Before beginning hormone therapy, your doctor should screen you for all relevant health conditions and ask you about your family’s medical history.

Myths and misconceptions to be aware of

Myth: Estrogen-based hormonal birth control is a feminizing treatment that can form a type of hormone therapy for people assigned male at birth.

Fact: Estrogen-based hormonal birth control won’t help with feminization.

Finding a trans-friendly healthcare provider can seem like a daunting task.

There are a few different ways to look for a doctor who suits you:

• Contact a trans-specific governmental organization in your area and ask if they could recommend a doctor.
• Talk to a primary care physician or general practitioner if you feel comfortable doing so.
• Ask transgender friends for a recommendation.
• Find online forums for trans people in your area, and ask whether they know of a trans-friendly care provider.

For more support, take a look at our guide on finding an LGBTQ-friendly healthcare provider.

People who are assigned female at birth — including transgender men taking testosterone — can take hormonal birth control pills safely.

However, people assigned male at birth — including transgender women — shouldn’t take hormonal birth control pills intended for people with uteruses.

Sian Ferguson is a freelance health and cannabis writer based in Cape Town, South Africa. She’s passionate about empowering readers to take care of their mental and physical health through science-based, empathetically delivered information.