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Transgender men report negative experiences, depression during pregnancy
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Transgender men who become pregnant are at increased risk for depression and difficulty getting medical care due to a lack of knowledge among health care providers, according to a literature review published in Maturitas.
“Despite the increased visibility of transgender people — there are about 1.4 million who have transitioned in the United States — medical providers are largely unprepared to care for them, and most have had limited educational opportunities,” Justin S. Brandt, MD, an assistant clinical professor in the department of obstetrics, gynecology and reproductive sciences at Rutgers Robert Wood Johnson Medical School, said in a press release. “The process of transitioning is long and arduous, and pregnancy, which is regarded as a feminine condition, forces these men to almost fully transition back to their sex assigned at birth, which can worsen gender dysphoria.”
The prevalence of pregnancy among transgender men is not known, and the demographic breakdown, including age, ethnicity and socioeconomic factors, is understudied, Brandt and colleagues wrote in the review. Nevertheless, expert opinion suggests that the number of pregnancies among transgender men is growing and will continue to increase in the future.
“The reproductive desires of transgender men appear to be similar to those of cisgender individuals,” the researchers wrote. “Some transgender men will have highly desired pregnancies whereas others perceive pregnancy as necessary to start a family. Studies suggest that unintended pregnancies are also common, occurring in approximately 30% of transgender men in one study.”
The researchers found that surveys of transgender men suggest that most who become pregnant will receive care from physicians and deliver in hospitals; however, it appears that
transgender men may seek medical care with non-physician providers and deliver at non-hospital locations at higher rates vs. the general population.
“In one survey, approximately 44% of transgender men delivered with non-physicians providers, including nurse midwives, and 17% delivered at home,” the researchers wrote. “The reasons for these differences are not well elucidated, but may be partially attributed to prior negative experiences in the traditional health care setting.”
The study also found that nearly 25% of transgender people reported negative health care experiences in the last year.
Researchers said there are limited data about obstetric outcomes, noting that vaginal birth rates among transgender men were 64% in one study, and approximately one-quarter of transgender men requested cesarean delivery on paternal request. Additionally, the impact of prior gender-affirming hormone treatment on labor and obstetric outcomes is unknown.
The researchers also found that about 51% of transgender men breast or chest fed their infants, even if they had breast surgery.
Brandt recommended that transgender men planning to conceive visit their physician before becoming pregnant to address routine issues, such as folic acid supplementation and screening for genetic disorders, and to be counseled on the risks of advanced-age pregnancy, such as infertility, miscarriage, gestational diabetes and pre-term delivery. Transgender men also likely will need to update health screenings that could have lapsed during transition, such as pap smears and, when indicated for those who have not had chest surgery, mammograms.
After delivery, Brandt said, physicians should address long-acting and reversible methods of contraception if the individual is at risk for unplanned pregnancy.
“Transgender men who intend to restart testosterone after delivery may decide to defer contraception since they perceive that their male hormone therapy induces a state of infertility, which is not always the case,” Brandt said in the release. – by Regina Schaffer
Disclosures: The authors report no relevant financial disclosures.
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