Transmasculine is used to describe an AFAB individual who identifies or presents toward the masculine side of the spectrum. This person may identify as a man or any number of other gender identities including nonbinary, genderqueer, or agender.Many AFAB folks who identify as men or who don’t identify as women have the reproductive organs necessary to carry a child. There are also emerging technologies that may make it possible for AMAB individuals to carry a child.
Your reproductive organs and hormones may change what pregnancy looks like, but your gender isn’t — and shouldn’t be — considered a limiting factor.
ConceptionFor those who opt to take testosterone, menses typically stop within six months of starting hormone replacement therapy (HRT). In order to conceive, a person will need to stop the use of testosterone. Still, it isn’t entirely unheard of for people who are on testosterone to become pregnant from having unprotected vaginal sex. Due to a lack of research and variations in individual physiology, it’s still not entirely clear how effective testosterone use is as a method of pregnancy prevention. Kaci, a 30 year-old trans man who has undergone two pregnancies, says that many doctors falsely tell people starting testosterone that it will make them infertile. “While there’s very little research that’s been conducted on gender non-conforming pregnancies or the effects of HRT on fertility, [the] data [that] is available happens to be overwhelmingly positive.” Take the results of one 2013 report, for example. The researchers surveyed 41 transgender men and transmasculine folks who had stopped taking testosterone and became pregnant. They found that most respondents were able to conceive a child within six months of stopping testosterone. Five of these people conceived without having first resumed menstruation.
Conception can happen in many ways, including sexual intercourse and through the use of assisted reproductive technologies (AST). AST may involve using sperm or eggs from a partner or donor.
PregnancyResearchers in the aforementioned 2013 survey didn’t find any significant differences in pregnancy between those who did and didn’t use testosterone. Some folks did report hypertension, preterm labor, placental interruption, and anemia, but these numbers were consistent with those of cisgender women. Interestingly, none of those respondents who reported anemia had ever taken testosterone. Anemia is common among cisgender women during pregnancy. However, pregnancy can be a challenging time emotionally.
Transgender men and transmasculine folks who become pregnant often experience scrutiny from their communities.As Kaci points out, “There’s nothing inherently feminine or womanly about conception, pregnancy, or delivery. No body part, nor bodily function, is inherently gendered. If your body can gestate a fetus, and that’s something you happen to want — then it’s for you, too.” People who experience gender dysphoria may find that these feelings intensify as their body changes to accommodate the pregnancy. The social association of pregnancy with womanhood and femininity can also lead to discomfort. Ceasing the use of testosterone may also exacerbate feelings of gender dysphoria. It’s important to note that discomfort and dysphoria aren’t a given for all trans folks who become pregnant. In fact, some people find that the experience of being pregnant and giving birth enhances their connection to their body.
The emotional impact of pregnancy is entirely dictated by each individual’s personal experience.
DeliveryThe survey administrators found that a higher percentage of folks who reported testosterone use prior to conception had a cesarean delivery (C-section), though the difference wasn’t statistically significant. It’s also worth noting that 25 percent of people who had a C-section elected to do so, possibly due to discomfort or other feelings around vaginal delivery.
The researchers concluded that pregnancy, delivery, and birth outcomes didn’t differ according to prior testosterone use.Although more research is necessary, this suggests that the outcomes for transgender, transmasculine, and gender non-conforming folks are similar to that of cisgender women.
PostpartumIt’s important that special attention be given to the unique needs of transgender people following childbirth. Postpartum depression is of particular concern. Studies show that 1 in 7 cisgender women experience postpartum depression. Given that the trans community experiences much higher rates of mental health conditions, they may also experience postpartum depression in higher numbers. The method of feeding a newborn is another important consideration. If you’ve elected to have a bilateral mastectomy, you may not be able to chestfeed. Those who haven’t had top surgery, or have had procedures such as periareolar top surgery, may still be able to chestfeed.
Still, it’s up to each individual to decide whether chestfeeding feels right for them.Although there has yet to be a study on transgender men and lactation, exogenous testosterone has long been used as a method for suppressing lactation. This suggests that those who do take testosterone while chestfeeding may experience a decreased production in milk. With this in mind, it’s important to consider whether delaying your return to testosterone use is the right choice for you.
Pregnancy via uterus transplantThe first baby born from a transplanted uterus arrived in Sweden during October of 2014. While this procedure is still in its early experimental stages, several other babies have been born through this method. Most recently, a family in India welcomed a baby from a transplanted womb, the first such case in the country. Of course, like many such technologies, this method was developed with cisgender women in mind. But many have begun to speculate that this procedure could also apply to transgender women and other AMAB folks. Dr. Richard Paulson, the former president of the American Society for Reproductive Medicine, suggested that uterine transplants for trans women and AMAB folks are more or less possible now. He added, “There would be additional challenges, but I don’t see any obvious problem that would preclude it.” It’s likely that supplementation to replicate hormonal phases during pregnancy would be necessary. Cesarean section would also be necessary for those who have undergone gender confirmation surgery.
Pregnancy via abdominal cavityIt has also been suggested that it may be possible for AMAB folks to carry a baby in the abdominal cavity. People have made this leap based on the fact that a very tiny percentage of eggs are fertilized outside of the womb in what is known as an ectopic pregnancy. However, ectopic pregnancies are incredibly dangerous for the gestational parent and typically require surgery. A significant amount of research would need to be done to make this a possibility for folks who don’t have a uterus, and even then, it seems incredibly unlikely that this would be a viable option for a hopeful parent.
It’s crucial not to subject those who do become pregnant to discrimination, and instead find ways to offer safe and supportive environments for them to build their own families.Likewise, it seems feasible that uterus transplants and other emerging technologies will make it possible for AMAB individuals to carry and give birth to children of their own. The best thing we can do is to support and care for all people who choose to become pregnant, regardless of their gender and the sex they were assigned at birth.
KC Clements is a queer, nonbinary writer based in Brooklyn, NY. Their work deals with queer and trans identity, sex and sexuality, health and wellness from a body positive standpoint, and much more. You can keep up with them by visiting their website, or by finding them on Instagram and Twitter.