Regardless of where you are on the gender spectrum – whether you are transgender (trans), non-binary, gendered, or gendered – you may need birth control, especially if there is a chance you could get pregnant and not try to.
Even if you are on sex-affirming hormone therapy – a type of treatment that allows you to match your gender characteristics to your gender identity – it doesn’t work very well as a method of birth control. If you have ovaries and a uterus, and have vaginal sex with someone who has testicles and a penis, you could get pregnant.
However, there are other reasons you might be taking birth control (you might call it birth control). For example, gender dysphoria – the feeling when your gender doesn’t match the gender you were assigned at birth – can worsen if you’re not binary or a trans man and start your period. Some birth control options can shorten or stop your period.
All birth control options that cisgender people use are available for non-binary and trans people. Still, some are better than others depending on other medications you may be taking.
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“If this is a patient with no other risk factors, then every option is available,” says Dr. Beth Cronin, obstetrician and gynecologist in Providence, RI. It depends on what your goals are and what side effects you want or can live with.
This is where contraception advice can help.
If you’re looking to avoid pregnancy, contraception counseling can help align your contraception with your family planning values and reproductive goals, says Dr. Adam Bonnington, obstetrician and gynecologist based in San Francisco.
Who Needs Birth Control?
Not all transgender people choose to transition with gender-affirming surgery or hormone treatments. You should discuss parenting and fertility decisions with your partner beforehand.
Doctors recommend birth control for most trans men and women, as well as non-binary people who have vaginal sex and do not want to get pregnant.
Transmasculine people
If you’re a transgender male or non-binary, have vaginal sex, and haven’t had a hysterectomy or bilateral oophorectomy (where the doctor removes your fallopian tubes and ovaries), you should use contraception. Testosterone Therapy (T) – a treatment that restricts the feminine characteristics and emphasizes the masculine – does not prevent pregnancy.
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People often think that if they don’t have a period, they can’t get pregnant. It’s unlikely, but not impossible, says Cronin. “We generally advise patients that if they have T and have this type of sex they could become pregnant and should use contraception.”
If you are transmasculin, on testosterone and wish to become pregnant, you must stop taking it.
Transfeminine people
Some transgender women or non-binary people receive estradiol therapy – a treatment that causes changes in your body caused by female hormones. It can help match the physical characteristics of your body with your gender identity, but it won’t work as a method of birth control when you are having vaginal sex. Hormone therapy is also not done as it doesn’t completely stop the sperm you are producing.
Types of hormonal therapies that are not contraceptive methods include:
- Cyproterone acetate
- Finasteride
- Gonadotropin-releasing hormone (GnRH) analogues
If you haven’t had a vasectomy (when a doctor cuts and closes the tubes of sperm) or orchidectomy (when a doctor removes your testicles), make sure your partner uses contraception if you have vaginal sex and don’t want to get pregnant .
Types of contraception and their use
How you use birth control depends on the method you and your partner choose.
The type that is right for you may not be right for someone else.
Some of the things that can influence your decisions include:
- How easy it is to use
- How much does it cost
- possible side effects
- Misconceptions you have about it
- Things That Make It Difficult to Get Birth Control
- Discrimination
- Your relationship with your doctor
Always speak to your doctor before adding anything new to your treatment regimen.
Condoms
Condoms are a popular form of birth control, but they don’t 100% prevent pregnancy. When you use condoms, you know that you or your partner may still get pregnant. If you use them correctly every time, there is a 2% chance they will fail. The typical failure rate for people who use condoms is 18%. You can use condoms with birth control to protect yourself from sexually transmitted diseases.
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IUDs
Another option is non-hormonal copper IUDs (they may be called Cu IUDs). These are completely safe to use and will not interact with any hormone treatments you may receive unless you are binary or a trans man. But there might be side effects you don’t want, like vaginal spots (where there is little blood) and bleeding.
Progestin-only methods
If you only plan to use progestogen contraception methods – such as levonorgestrel intrauterine systems (IUS), implants, injections, or pills – talk to your doctor first. Some doctors don’t think being trans or non-binary will affect the hormonal treatments you may receive, but others don’t recommend it.
Given the lack of data on potential risks, side effects, and benefits specific to transgender and non-binary individuals using gender-affirming testosterone in combination with estrogen-based contraceptives, Bonnington believes that it is best to avoid these products, be it because there is a definite benefit or you have a strong preference.
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Injections or IUS can help stop or reduce bleeding from your vagina.
If you want to avoid bleeding, consider a method like the progestin-only implant, intrauterine system, or injection, says Bonnington.
Combined hormonal contraceptives (CHCs)
Transgender men and non-binary individuals treated with testosterone should not use combined hormonal contraceptives (CHC) – patches, pills, or the vaginal ring – that contain estrogen and progestin. That’s because CHC contains estrogen, which can potentially interfere with testosterone.
If you’ve had top surgery (where a surgeon removes breast tissue to create a more masculine breast), drugs that contain estrogen, such as birth control pills, band-aid, or the ring, can cause breast tenderness or pain. “Some people notice gas and the like, but it really will depend on the person,” says Cronin.
More permanent options
There are more permanent forms of birth control as well. Either partner can have a vasectomy or tubal ligation (where a surgeon ties, cuts, or blocks your fallopian tubes). Both procedures will help prevent conception.
So speak to your doctor’s office and pharmacy
According to a recent study, 56% of lesbian, gay or bisexual and 70% of transgender people say they have experienced discrimination when seeking medical care.
Sometimes the best way to find LGBTQ-friendly providers is through word of mouth from family or friends, says Cronin. Local LGBTQ organizations often have lists of providers to refer their patients to, Bonnington adds.
Signs that the provider is LGBTQ friendly include:
- A clearly posted sign with a non-discrimination policy that includes protection of gender identity and expression
- A waiting room with educational brochures, magazines or posters about transgender health
- Bathroom for all genders
- Admission forms asking for your correct name, pronouns, gender identity, and gender assigned at birth
- Vendors whose pronouns are on their name tags
Still, he says, these aren’t guarantees that a provider or clinic is LGBTQ friendly.
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