Contraception Knowledge in Transgender Individuals: Are we Doing Enough? [9F]

Abstract

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.

Pregnancy in a Transgender Male: A Case Report and Review of the Literature

“…Furthermore, increasing evidence that pregnancy is possible in transgender individuals highlights the importance of counseling these patients about contraception to avoid an unwanted pregnancy. Unplanned pregnancies have occurred in transgender male patients, and contraception is often an area overlooked by many health care professionals when treating transgender patients [ 9 ].…”

Inclusion of LGBTQ persons in research related to pregnancy risk: a cognitive interview study

“…For example, they may not investigate whether and to what extent hormone replacement therapies may prevent pregnancy, a topic still under debate by medical researchers 24. Researchers who want to include LGBTQ individuals in research about abortion and contraception should make sure their studies are able to deepen understanding of the needs and experiences of LGBTQ individuals and ways to meet these needs.…”

Contraceptive Counseling for the Transgender Patient Assigned Female at Birth

“…Contraception must be discussed with all people who present a risk of unplanned pregnancy. 7,[9][10][11] In Brazil, there is a higher prevalence of the use of oral pills (29.7%) by cisgender women, followed by tubal ligation (14%) and external condoms (10%). 12 Hormonal methods are divided into two groups: combined and progestogen-only contraceptives.…”

“…9 For this reason, erroneously, 16.4 to 31% of TM believe that testosterone is a contraceptive. 7,10,24 The presence of estrogen in contraceptive methods is one of the factors that leads TM undergoing hormonization to the use of nonhormonal methods or of progestogen alone. 9,10,25,26 Currently, there is no evidence of the influence of contraceptive use on the acquisition of secondary male characteristics.…”