Contraception in Transgender People Who Were Assigned a Female Sex at Birth – A Narrative Review

Albuquerque Brás, Sofia; Isidro Amaral, Patricia; Machado, Ana Isabel

http://hdl.handle.net/10400.17/5168

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Authors

Albuquerque Brás, Sofia

Isidro Amaral, Patricia

Machado, Ana Isabel

Abstract(s)

Background and Purpose: Transgender people often experience suboptimal contraception counseling due to clinicians’ insufficient experience in this topic, and practitioners themselves report lack of satisfactory training. We aim to summarize the current literature on contraception counselling in transgender men and nonbinary people assigned female at birth. Methods: The present article is a narrative review. Searches were performed in Pubmed and Google Scholar databases using the terms ‘transgender’, ‘transmen’, ‘contraception’, ‘family planning’, ‘reproductive care’. Only English and Portuguese written articles published in the last six years were considered. A manual search of references from identified studies was also conducted and international guidelines were searched for information of interest. Results: Existing literature suggests that transgender men and nonbinary people assigned female at birth experience significant barriers to health services that can compromise their reproductive health. Regarding contraceptive options, all methods can be offered, according to the same eligibility criteria used for cisgender women. Nevertheless, specificities must be considered: differential acceptance of side effects, potential emotional and physical discomfort inherent to pelvic examination. Both patients and their healthcare providers may be unaware of the fact that ovulation may occur during testosterone treatment, even if the person is in amenorrhea. Hence, it should not be considered for effective contraception. Also, it has known teratogenic effects, which highlights the need for preventing unplanned pregnancies. Until date, there is no evidence that testosterone use is a contraindication to any contraceptive method, therefore, transmen on this medication should be offered all options. Conclusions: All contraceptive methods can be offered to transgender men and nonbinary individuals assigned female at birth, but the specific needs and concerns of these individuals should be considered in counseling. Literature on this field is still scarce and more studies are needed to evaluate preferences and satisfaction rates.