Contraception for trans individuals

Trans and gender diverse (trans) individuals have a different gender identity from that originally presumed or assigned at birth. As for all individuals wanting to prevent pregnancy, contraceptive choice is influenced by multiple factors (see Overview of factors affecting contraceptive choice). Gender identity does not restrict choice of contraceptive method, but additional factors may need consideration in trans individuals.

For trans individuals presumed female at birth (ie trans men and some nonbinary individuals):

• Although testosterone can cause amenorrhoea, it does not provide adequate contraception, and is contraindicated in pregnancy due to its teratogenic effect on a female fetus.
• Estrogen-containing contraceptives are not recommended if testosterone therapy is being used; progestogen-only methods can be used.
• A desire for amenorrhoea may influence choice of contraceptive method. A levonorgestrel-releasing intrauterine contraceptive device (LNG-IUD) or depot medroxyprogesterone can be useful choices; for individuals not using testosterone therapy, continuous use of combined hormonal contraception can effectively reduce blood loss.
• Body dysphoria in relation to genital procedures can impact on the procedure for inserting intrauterine contraception and cause distress; consider using distraction techniques or sedation.

For trans individuals presumed male at birth (ie trans women and some nonbinary individuals):

• Although estrogen therapy impairs spermatogenesis, it cannot be relied on for contraception.
• For those who have not undergone orchiectomy, contraceptive options are limited to vasectomy and condoms.

See also Trans and gender diverse health for other aspects of healthcare.