For the health and well-being of transgender parents-to-be and their families, it’s important to understand where we’ve been — and where we need to go.
Pregnancy and birth have widely been considered something that women do. But in reality, people of all genders get pregnant and give birth to babies around the world.
Medicine is on the cusp of possibility for a transgender woman to bear a child with a transplanted uterus.
But for now, most transgender people giving birth are those born with a uterus — transgender men, nonbinary people, gender fluid people, gender queer people, Two-Spirit people, and others with uteruses who don’t identify as women.
Many transgender men are incorrectly told by health professionals that taking testosterone will make them “sterile” and potentially unable to conceive. This can result in unplanned pregnancies or a lack of awareness that desired pregnancy is possible.
Actually, the first study that looked at female-to-male transgender people receiving in vitro fertilization was published in October 2019 and found that egg quality and quantity were similar between transgender men and cisgender women.
While taking testosterone, ovulation may stop (usually within
If a transgender man stops taking his testosterone, his menstrual cycle often returns, reportedly within about 6 months. While there have been no long-term studies, nothing so far has shown cause for concern.
Reproductive endocrinologist Dr. Sara Pittenger Reid told the New York Times that with the “limited amount of data we have” it seems that taking testosterone before pregnancy doesn’t have any effect on the baby’s health.
Trystan Reese transitioned in his early 20s and the endocrinologist managing his testosterone therapy informed him that he would become infertile and never be able to carry a child — that the testosterone would render his uterus “uninhabitable.”
In his 30s, Reese carried and birthed a healthy baby in 2017.
“I am not a fluke,” Reese wrote for Family Equality, an organization dedicated to LGBTQ+ families. “Hundreds and maybe thousands of transgender men all over the world have successfully given birth or otherwise contributed their eggs to a pregnancy.”
The exact number of transgender people to carry pregnancies is unknown, but a 2019 news release from Rutger’s University said their new research suggests up to 30 percent of transgender men have had unplanned pregnancies.
But physical health isn’t the main barrier facing pregnant transgender men and nonbinary people. Social stigma is.
The language and culture around pregnancy and birth is highly gendered, from the terms “maternity ward” and “women’s health,” to the assumptions someone in the grocery store makes about a pregnant person passing by.
The factors that most people don’t think of twice can cause significant hurt for pregnant people who aren’t women.
“The whole process is difficult — it really is tailored for women, essentially, in the language and everything about it,” Ethan Clift told NBC News.
Clift said that when he was pregnant he corrected health professionals caring for him at a Reno, Nevada clinic who called him “she” over and over until he gave up.
Others have described “getting laughed at” by providers, nurses refusing to see them, and being denied lactation coaching in the hospital.
Treatment like this is part of why 30.8 percent of transgender patients delayed or didn’t seek medical attention, according to a 2016 study.
One transgender man told a researcher in a 2017 study: “I just didn’t like leaving the house at all because I knew that I was going to be read as pregnant female, and it just ugh. After I’d worked so hard the past couple of years to get [people to see me as male].”
Another man in the same study said: “I had heard many times over that [providers] felt uncomfortable with me… [A transgender male patient seeking pregnancy] was too new and too different for them… so I think that they were afraid of helping, and getting it wrong, in addition to feeling uncomfortable.”
Much of a transgender pregnant person’s experience can be improved by the people around them respecting their gender and avoiding making assumptions.
Here are some tips for healthcare professionals, as well as anyone coming into contact with pregnant people:
- Use gender-neutral language, i.e. say “pregnant people” instead of “pregnant women.”
- Use language about parts, i.e. say “uterus and ovaries” instead of “female reproductive system.”
- Ask a pregnant person for their pronouns (i.e. he/him/his, she/her/hers, they/them/theirs) and consistently use the ones they tell you.
- Ask for and use the pregnant person’s preferred name, which isn’t necessarily their legal name.
- Ask for gender identity (which is different than sex at birth or sexual orientation) on intake forms and have staff check what’s written before addressing the patient.
- Provide single-stall gender-neutral bathrooms.
- Train all staff on the practices above and further cultural competency.
There are many resources available now for both pregnant people and healthcare providers:
- “Trans Masculine Fertility” online course (FertilityIQ)
- “Family Building for the Trans Community” PDF handbook (Family Equality)
- “Preparing for Pregnancy as a Non-Binary Person” (Family Equality)
- “All Pregnant People: A Digital Trans Pregnancy Training for Birthworkers” (Trans Fertility Co.)
- “Trans Dads” podcast episode (Family Equality)
- “Trans Fertility 101” recorded webinar (Family Equality)
- “What Doesn’t Bend, Breaks: Resiliency Strategies for Trans Folks on Fertility Journeys” (Family Equality)
- “Building Your Family: LGBTQ Reproductive Options” recorded webinar (Fenway Institute)
- “Trans Fertility Considerations” online course (Family Equality)
- “Navigating Gender Affirming Care” recorded webinar (Fenway Institute)
- “Where’s the Mother? Stories from a Transgender Dad” book (Trevor MacDonald)
“As more people go through this and are supported, it will make more people comfortable seeking support,” says Dr. Sara Pittenger Reid.
The more competent the care, the more healthy the pregnant person and their baby — which is the outcome everyone should strive for.
Sarah Prager’s writing has appeared in the New York Times, The Atlantic, National Geographic, HuffPost, JSTOR Daily, Bustle, The Advocate, and many other outlets. She’s the author of two books for youth about LGBTQ+ heroes of history: “Queer, There, and Everywhere: 23 People Who Changed the World” and “Rainbow Revolutionaries: 50 LGBTQ+ People Who Made History.” She lives in Massachusetts with her wife and their two children. Learn more about Sarah here.