INTRODUCTION:
Transgender individuals are often reluctant to seek reproductive health care and have under-addressed needs. Our objective is to determine use and awareness of contraceptive methods and views on abortion in this population.
METHODS:
Transgender patients ages 18-65 participated in an online survey about reproductive history, contraceptive use and knowledge, and abortion views.
RESULTS:
100 transgender men and 20 transgender women completed the survey. The mean age of transgender men and women was 22.9 (SD 5.6) and 25.9 (SD 9.5) respectively. The majority was white (85%). 76/101 (75%) were at risk of unintended pregnancy. 30/97 (31%) transgender men and 12/18 (67%) transgender women believed or were unsure if testosterone or estrogen therapy prevents pregnancy. 1/18 (6%) transgender women and 9/93 (9%) transgender men indicated that a provider stated gender affirming hormones prevented pregnancy. Over 70% had knowledge of condoms, oral contraceptive pills, and sterilization. 70% of transgender men were also aware of the contraceptive ring and implant. However, only 18/89 (20%) transgender men and 4/11 (36%) transgender women used contraception. 8/17 (47%) transgender women and 44/87 (51%) transgender men stated a provider did not discuss contraception after initiating hormone therapy. There were no unplanned pregnancies (0/16, 0%) in partners of transgender women. 3/93 (3%) transgender men had unplanned pregnancies. 2/3 chose abortion. The vast majority (95%) identify as pro-choice.
CONCLUSION:
Although many transgender individuals in our cohort were at potential risk of pregnancy, contraceptive use was limited. This highlights need for educational interventions for patients and providers and increased access to contraceptive and reproductive services.
Introduction:The intrauterine device (IUD) is a long-acting and highly efficacious form of contraception that can also be used for menstrual suppression. Although IUD use is increasing, the type chosen, appeal, and satisfaction among individuals who are transgender and gender diverse and assigned female at birth (TGD-AFAB) is unknown. The purpose of this study is to evaluate IUD usage among TGD-AFAB individuals.Methods: TGD-AFAB individuals who had an IUD for a minimum of 6 months at the time of completing the survey or had one in the past completed an anonymous online survey. Descriptive statistics were used to analyze the data.Results: One hundred and five TGD-AFAB individuals completed the survey. Among participants who were sexually active, 88% reported they were in a relationship in which it was possible to get pregnant. There were 85 individuals who currently had an IUD: 62 (73%) chose a 52-mg levonorgestrel (LNG) IUD, 5 (6%) chose a lower-dose LNG IUD, 17 (20%) chose the copper IUD, and one chose an IUD unavailable in the United States. Menstrual suppression was the primary reason for choosing a 52-mg LNG IUD (58%). Most individuals who opted for a copper IUD did so to avoid hormonal contraception (71%). Participants reported experiencing IUD side effects; however, few desired removal. Among the 36 respondents who had an IUD in the past, the most frequent reasons for removal were expiration of the device (LNG IUDs) and undesired side effects (copper IUD). Approximately half of participants who had an IUD removed had it replaced with another IUD.Discussion: Pregnancy can occur among TGD-AFAB individuals even if they are on testosterone and amenorrheic. IUDs are well tolerated in this population, with few current users desiring removal for unwanted side effects. Clinicians should counsel TGD-AFAB individuals about the contraceptive and noncontraceptive benefits of IUDs and expected side effects.
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