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Chapter 22 - Contraceptive Advice for Trans Male Persons

from Section D - Sexuality and Contraception

Published online by Cambridge University Press:  22 December 2022

By
Giulia Gava ,
Ilaria Mancini  and
Maria Cristina Meriggiola
Edited by
Mick van Trotsenburg ,
Rixt A. C. Luikenaar  and
Maria Cristina Meriggiola
Mick van Trotsenburg
Affiliation:
Sigmund Freud PrivatUniversität, Wien
Rixt A. C. Luikenaar
Affiliation:
Rebirth Health Center, Utah
Maria Cristina Meriggiola
Affiliation:
Università di Bologna
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Summary

Unintended pregnancies among transgender men undergoing gender-affirming hormonal treatments (GAHTs) with testosterone (T) have been reported, and T cannot be considered a contraceptive method, due to the incomplete suppression of gonadal function. Despite that, awareness about the necessity of concomitant contraception during T treatment is lacking among transgender individuals, but also among clinicians. Data are scarce regarding the best contraceptive choice in transgender men: some considerations are the same as those for cisgender women, but benefits and risks of any contraceptive option should be discussed, recognizing differences in needs and concerns in this population. Trans men who still have their ovaries and uterus and engage in sexual activity with a person with a penis and testicles should be counseled regarding contraception. Gender-affirming hormone therapy (GAHT) alone should not be considered a reliable form of contraception. For this reason, this topic and the discussion of fertility and family planning should be covered before the start of GAHT and rediscussed during follow-up visits.

Type
Chapter
Information
Context, Principles and Practice of TransGynecology
Managing Transgender Patients in ObGyn Practice
 , pp. 168 - 171
Publisher: Cambridge University Press
Print publication year: 2022

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References

Irwig, MS. Testosterone therapy for transgender men. Lancet Diabetes Endocrinol 2017;5(4): 301–311.Google Scholar
Spinder, T, Spijkstra, JJ, van den Tweel, JG, et al. The effects of long-term testosterone administration on pulsatile luteinizing hormone secretion and on ovarian histology in eugonadal female to male transsexual subjects. J Clin Endocrinol Metab 1989;69:151–157.CrossRefGoogle ScholarPubMed
Krempasky, C, Harris, M, Abern, L, Grimstad, F. Contraception across the transmasculine spectrum. Am J Obstet Gynecol 2020;222(2):134–143.CrossRefGoogle ScholarPubMed
De Roo, C, Lierman, S, Tilleman, K, et al. Ovarian tissue cryopreservation in female-to-male transgender people: insights into ovarian histology and physiology after prolonged androgen treatment. Reprod Biomed Online 2017;34(6):557–566.Google Scholar
Berra, M, Armillotta, F, D’Emidio, L, et al. Testosterone decreases adiponectin levels in female to male transsexuals. Asian J Androl 2006;8:725–729.Google Scholar
Perrone, AM, Cerpolini, S, Maria Salfi, NC, et al. Effect of long-term testosterone administration on the endometrium of female-to-male (FtM) transsexuals. J Sex Med 2009;6(11):3193–3200.Google Scholar
Deutsch, MB, Bhakri, V, Kubicek, K. Effects of cross-sex hormone treatment on transgender women and men. Obstet Gynecol 2015;125(3):605–610.Google Scholar
Goodman, NF, Cobin, RH, Futterweit, W, et al. American Association of Clinical Endocrinologists, American College of Endocrinology, and Androgen Excess and PCOS Society Disease State Clinical Review: guide to the best practices in the evaluation and treatment of polycystic ovary syndrome: part 1. Endocr Pract 2015;21: 1291–1300.Google Scholar
West, S, Vähäsarja, M, Bloigu, A, et al. The impact of self-reported oligo-amenorrhea and hirsutism on fertility and lifetime reproductive success: results from the Northern Finland Birth Cohort 1966. Hum Reprod 2014;29:628–633.Google Scholar
Casteràs, A, De Silva, P, Rumsby, G, Conway, GS. Reassessing fecundity in women with classical congenital adrenal hyperplasia (CAH): normal pregnancy rate but reduced fertility rate. Clin Endocrinol 2009;70: 833–837.Google Scholar
Hembree, WC, Cohen-Kettenis, PT, Gooren, L, et al. Endocrine treatment of gender-dysphoric/gender-incongruent persons: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2017;102(11): 3869–3903.Google Scholar
Gava, G, Mancini, I, Cerpolini, S, et al. Testosterone undecanoate and testosterone enanthate injections are both effective and safe in transmen over 5 years of administration. Clin Endocrinol 2018;89:878–886.CrossRefGoogle ScholarPubMed
Futterweit, W. Endocrine therapy of transsexualism and potential complications of long-term treatment. Arch Sex Behav 1998;27(2):209–226.CrossRefGoogle ScholarPubMed
Grimstad, FW, Fowler, KG, New, EP, et al. Uterine pathology in transmasculine persons on testosterone: a retrospective multicenter case series. Am J Obstet Gynecol 2019;220(3):257.e1–257.e7.CrossRefGoogle ScholarPubMed
Loverro, G, Resta, L, Dellino, M, et al. Uterine and ovarian changes during testosterone administration in young female-to-male transsexuals. Taiwan J Obstet Gynecol 2016;55(5):686–691.Google Scholar
T’Sjoen, G, Arcelus, J, Gooren, L, Klink, DT, Tangpricha, V. Endocrinology of transgender medicine. Endocr Rev 2019;40(1):97–117.CrossRefGoogle ScholarPubMed
Taub, RL, Ellis, SA, Neal-Perry, G, et al. The effect of testosterone on ovulatory function in transmasculine individuals. Am J Obstet Gynecol 2020;S0002–9378(20):30134–30134.Google Scholar
Schubert, FD, Carey, JM. Data unclear on pregnancy risk in transmasculine individuals on testosterone. Am J Obstet Gynecol 2020;222(4):393–394.CrossRefGoogle ScholarPubMed
Gomez, A, Walters, P, Dao, LT. “Testosterone in a way is birth control”: contraceptive attitudes and experiences among transmasculine and genderqueer young adults. Contraception 2016;94(4):422–423.CrossRefGoogle Scholar
Light, A, Wang, L-F, Zeymo, A, Gomez-Lobo, V. Family planning and contraception use in transgender men. Contraception 2018;98:266–269.CrossRefGoogle ScholarPubMed
Light, AD, Obedin-Maliver, J, Sevelius, JM, Kerns, JL. Transgender men who experienced pregnancy after female-to-male gender transitioning. Obstet Gynecol 2014;124:1120–1127.CrossRefGoogle ScholarPubMed
Testosterone: Drug information. In Lexicomp Drug Information Handbook. [Alphen aan den Rijn]. The Netherlands: Wolters Kluwer, 2018.Google Scholar
Schwartz, AR, Russell, K, Gray, BA. Approaches to vaginal bleeding and contraceptive counseling in transgender and gender nonbinary patients. Obstet Gynecol 2019;134(1):81–90.CrossRefGoogle ScholarPubMed
Abern, L, Maguire, K. Contraception knowledge in transgender individuals: are we doing enough? Obstet Gynecol 2018;131:65S.CrossRefGoogle Scholar
Cipres, D, Seidman, D, Cloniger, C 3rd, et al. Contraceptive use and pregnancy intentions among transgender men presenting to a clinic for sex workers and their families in San Francisco. Contraception 2017;95(2):186–189.Google Scholar
Stark, B, Hughto, JMW, Charlton, BM, et al. The contraceptive and reproductive history and planning goals of trans-masculine adults: a mixed-methods study. Contraception 2019;100(6):468–473.Google Scholar
Curtis, KM, Tepper, NK, Jatlaoui, TC. U.S. Medical Eligibility Criteria for Contraceptive Use. Published 2016. MMWR Recomm Rep 2016;65(3):1–104.Google Scholar
World Health Organization. Medical Eligibility Criteria for Contraceptive Use. Published 2015.Google Scholar
Faculty of Sexual and Reproductive Healthcare. UK Medical Eligibility Criteria for Contraceptive Use (UKMEC). Published 2016.CrossRefGoogle Scholar
Wolters Kluwer Health, Inc. Medroxyprogesterone acetate. Lexi-Drugs. LexiComp. Available at: http://online.lexi.comGoogle Scholar
Boudreau, D, Mukerjee, R. Contraception care for transmasculine individuals on testosterone therapy. J Midwifery Womens Health 2019;64(4):395–402.CrossRefGoogle ScholarPubMed
Francis, A, Jasani, S, Bachmann, G. Contraceptive challenges and the transgender individual. Womens Midlife Health 2018;4:12.Google Scholar
Meriggiola, MC, Gava, G. Endocrine care of transpeople part I. A review of cross-sex hormonal treatments, outcomes and adverse effects in transmen. Clin Endocrinol 2015;83(5):597–606.Google Scholar
Baillargeon, J, Urban, RJ, Morgentaler, A, et al. Risk of venous thromboembolism in men receiving testosterone therapy. Mayo Clin Proc 2015;90:1038–1045.Google Scholar
Snyder, PJ, Ellenberg, SS, Farrar, JT. Effects of testosterone treatment in older men. N Engl J Med 2016;374:611–624.CrossRefGoogle ScholarPubMed
Shatzel, JJ, Connelly, KJ, DeLoughery, TG. Thrombotic issues in transgender medicine: a review. Am J Hematol 2017;92:204–208.CrossRefGoogle ScholarPubMed
Trussell, J, Aiken, ARA, Micks, E, Guthrie, KA. Efficacy, safety, and personal considerations. In Hatcher, RA, Nelson, AL, Trussell, J, et al, Eds. Contraceptive Technology (21st ed.). New York: Ayer Company Publishers, Inc., 2018.Google Scholar
American College of Obstetricians and Gynecologists. Practice Bulletin No. 208 Summary: Benefits and Risks of Sterilization. Obstet Gynecol 2019;133(3):592–594.Google Scholar

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