OPINION: Trans men’s reproductive health needs more research

by Dr. Lynae Brayboy | Clue
Tuesday, 24 November 2020 09:11 GMT

FILE PHOTO: An illustration picture shows a blister-pack of birth control pills displayed at a private home in Nice January 3, 2013.

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* Any views expressed in this opinion piece are those of the author and not of Thomson Reuters Foundation.

Trans health issues are public health issues and reproductive health disparities that exist need addressing

Dr. Lynae Brayboy is chief medical officer at the period tracking app Clue

An important aspect of reproductive health is contraception. Unfortunately, for many transgender men, this choice can be difficult. There is very little research to inform their choices and very few healthcare professionals with clinical expertise in trans reproductive care, which includes pregnancy, fertility and sexual function as well as contraception.

Taking testosterone can help produce desired, gender-affirming characteristics for many trans men. As well as facial hair and a lower voice, this can include amenorrhea, or the absence of spontaneous periods – something that may be welcomed.

However, it’s important to note that testosterone is not a contraceptive and people can become pregnant despite not having a period. This means that reliable contraception is still very important for trans men who don’t want to become pregnant, even when taking testosterone.

There is no clinical consensus on what the most appropriate contraceptive option is when it comes to the transition process for trans men.

A very commonly prescribed method is the oral contraceptive pill. Both components of the oral contraceptive pill work independently to impede the production and effect of androgens (hormones associated with male characteristics, like testosterone and androstenedione) that are made naturally by the ovaries and adrenal glands.

So there is a possibility that combined contraceptive pills could negate the desired effects of gender-affirming hormone therapy for trans men.

However, there is not enough data to really know with certainty whether this is the case. This is why we need further clinical research, and better enrollment of trans men in contraceptive studies in general: so we have more data.

One method of contraception that transgender men could consider could be methods that just use progestin – a synthetic version of the natural female reproductive hormone progesterone. These have a singular impact on testosterone production, rather than the dual one that the combined pill has.

They could also consider a hormonal IUD (intrauterine device), a t-shaped device that sits inside the uterus and which has the benefit of at least 20% of users having no period.

Finally, the etonogestrel progestin implant is the most effective form of birth control and many individuals experience infrequent period bleeding. But of course this implant, like the IUD, needs to be placed by a trained healthcare professional. Keep in mind that everyone is different so your bleeding profile could vary.

In the U.S, it was only in 1993 that the National Institute of Health policy required women to be included in all of the research that the body supported. Now, I think that it is time for the mandate to be re-evaluated, to make sure all genders are included.

There are an estimated 1.5 million trans people in the United States, but unfortunately there is really sparse data about trans individuals across the field of reproductive health. Even emerging research, such as a study published this year on ovulation while taking testosterone by scientists at the University of Washington, concludes that further research is needed.

Anyone reading this - whether a trans person, an ally or otherwise - can petition their governmental representatives and local health officials to fund and approve studies. There is the PRIDE study, which is tracking the long-term health of LGBT+ people, but we also need new ones that specifically study both fertility, pregnancy and  contraceptive options for transgender and/or non-binary individuals.

We can also direct our attention towards volunteering for trans reproductive justice initiatives, shaping medical education, and increasing our own awareness of the increased violence against Black trans lives.

Trans health issues are public health issues and we need everyone’s help to address the reproductive health disparities that exist.


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