Birth Control: Types and Considerations for Transgender and Nonbinary People
No matter where you are on the gender spectrum, you might choose to use birth control if there’s a chance you could get pregnant and you don’t want to.
Not all people who are transgender, nonbinary, or gender expansive choose to get gender-affirming care. But some people do take hormone therapy as part of their medical care to help align their sex characteristics with their gender identity. If you do, keep in mind that gender-affirming hormone therapy isn’t made for birth control, so you shouldn’t rely on it for that purpose.
Some people might also consider certain types of hormonal birth control for other reasons. For example, gender dysphoria – distress when your gender doesn’t match the sex assigned to you at birth – can get worse if you identify as male but were assigned female at birth and get your period. Some birth control options can lessen or stop your period.
Birth control is not designed for any particular gender identity. Anything that cisgender people might choose is available for everyone. The type of contraceptive that’s best for you depends on your situation.
“If it’s for a patient with no other risk factors, any option is available,” says Beth Cronin, MD, an obstetrician-gynecologist in Providence, RI. Things that may affect your decision include your health, family planning goals, and what side effects you’re willing or able to live with.
Contraceptive counseling can help you decide which option best matches your goals, says Adam Bonnington, MD, an obstetrician-gynecologist in San Francisco. (Contraceptive is another word for birth control.)
If your goal is to avoid pregnancy, you may want to consider birth control if:
- You have ovaries and a uterus, you have not gone through menopause, and you have vaginal sex with someone who has testicles and a penis.
- You have testicles and a penis, and you have vaginal sex with someone who has ovaries and a uterus who hasn’t been through menopause and doesn’t want to get pregnant.
You and your partner may want to discuss what you each want and what the options are.
Trans men and nonbinary people: If you take testosterone therapy (T) to curb feminine traits and bring out masculine ones, it will stop your periods. Some people assume that means they can’t get pregnant. But while a pregnancy for someone in this situation is unlikely, it’s not impossible, Cronin says.
“We generally counsel patients that if they’re on T and are having that type of sex, they could get pregnant and they should be using contraception,” she says.
If you take testosterone as part of your gender-affirming care, and you want to get pregnant, you’ll have to stop taking it.
Trans women and nonbinary people: Some trans women and nonbinary people take estradiol therapy as a feminizing hormone. That treatment won’t work as birth control. Neither will hormonal therapy that curbs masculine traits, because it doesn’t completely stop sperm production.
If you haven’t had a vasectomy (when a doctor cuts and seals the tubes that carry sperm) or orchiectomy (surgery to remove the testicles), and you have vaginal sex with your partner, make sure they use birth control if they don’t want to get pregnant. You can also use a barrier method, such as a condom, but condoms do not work as well as other forms of birth control.
Other types of hormonal therapies that aren’t birth control methods include:
- Cyproterone acetate
- Gonadotropin-releasing hormone (GnRH) analogues
There are several types of birth control. The type that’s right for you might not be right for someone else.
Things that can affect your decisions include:
- How easy it is to use
- Possible side effects
- Misconceptions you have about it
- Things that make it hard to get birth control
- Discrimination or bias
- Your relationship with your doctor
Talk to your doctor if you have questions about your options.
Condoms will help protect you from sexually transmitted diseases (STDs). But to avoid pregnancy, you should also use another form of birth control.
If condoms are the only form of contraception you use – and you use them perfectly, every time you have vaginal sex – there’s about a 2% chance that you could get pregnant. But most people don’t always use them correctly, driving up the odds of getting pregnant to about 13% if you’re not using a second form of contraception.
Intrauterine devices (IUDs) are shaped like a T. A doctor inserts an IUD into your uterus for long-term, highly effective contraception. It’s a quick process, but you’ll want to make sure you’re comfortable with that.
There are 5 types of IUDs approved in the U.S. Four of them release very small amounts of the hormone progestin, which will not cause any feminizing effects. The fifth type is a nonhormonal copper intrauterine device (you might hear these called Cu-IUDs).
Side effects can include vaginal spotting (where there’s only a little bit of blood) and bleeding. Some people also get cramps related to their IUD. But most people stick with the IUDs, according to a 2021 study published in the Journal of Midwifery and Women’s Health. That study was based on a survey of 105 trans men and gender diverse people with IUDs who had been assigned female at birth. The IUDs were “well tolerated,” the researchers wrote, with few people seeking to remove them because of side effects.
Progesterone is a hormone that your body makes. Progestin is a synthetic version of it.
Progesterone-only methods of birth control include some IUDs (levonorgestrel intrauterine systems), implants, shots, or pills. Talk to your doctor about it first.
Shots or IUDs could help you stop or lessen bleeding from your vagina. To avoid bleeding, you may want to choose a method like the progestin-only implant, IUD, or shot, Bonnington says.
Combined hormonal contraceptives (CHCs)
Combined hormonal contraceptives (CHCs) include patches, pills, and the vaginal ring. They contain estrogen and progestogen. There isn’t enough feminizing hormone in these contraceptives to affect testosterone therapy.
If you’ve had top surgery (surgery to remove breast tissue to create a more masculine chest), medications with estrogen – such as birth control pills, patches, or the ring – might make your breasts feel tender or sore. “Some people note some bloating and things like that, but it’s really going to depend on the person,” Cronin says.
More permanent options
There are also more permanent forms of birth control. Either partner can get a vasectomy or tubal ligation (surgery to cut, tie, or block the fallopian tubes). Both procedures will help prevent conception.
Many transgender and nonbinary people say they’ve been discriminated against or otherwise not treated respectfully in health care settings.
Sometimes the best way to find LGBTQ-friendly providers is through word of mouth from family or friends, Cronin says. Local LGBTQ organizations often have a list of providers they refer people to, Bonnington says.
Signs the provider is LGBTQ-friendly can include:
- A posted sign with nondiscrimination policies that include gender identity and expression protections
- A waiting room with educational brochures, magazines, or posters about transgender health
- A bathroom labeled for all-gender use
- Intake forms that ask for your correct name, pronouns, gender identity, and sex assigned at birth
- Providers who have their pronouns on their name badges
Still, he says, these aren’t guarantees that a provider or clinic is LGBTQ-friendly.