This article is more than 5 years old. Information may no longer be current.

Pregnant transgender men at risk for depression, gender dysphoria

Transgender men who become pregnant are at increased risk for depression and gender dysphoria; however, getting the proper medical care can be challenging due to a lack of knowledge among health care providers, according to a literature review published in Maturitas.

Although some transgender men undergo hormonal treatment and/or surgery, many retain their capacity to become pregnant. Currently, medical providers are largely unprepared to care for transgender people, who also face psychosocial barriers for care, such as social discrimination and rejection from insurance companies to cover gender-affirming treatment, Justin S. Brandt, MD, assistant clinical professor in the department of obstetrics, gynecology and reproductive sciences at Rutgers Robert Wood Johnson Medical School, and colleagues wrote.

“In our study, we wanted to explore evidence-based practice for transgender men during pregnancy, especially for men over the age of 35,” Brandt told Healio Psychiatry.

However, after performing an extensive literature review, the researchers found limited research on transgender men, obstetrical care and outcomes.

The main findings, based mostly on cross-sectional surveys and expert opinion, were that transgender men and cisgender women have similar attitudes about pregnancy, according to Brandt.

In one study, unintended pregnancy occurred in about 30% of transgender men, suggesting it may be more common than previously believed. The researchers highlighted the importance of contraception counseling.

For those who would like to become pregnant, Brandt and colleagues recommended transgender men should see their doctor before becoming pregnancy to discuss routine issues and those aged 35 years or older should know about the risks of advanced-age pregnancy, such as miscarriage, infertility, preeclampsia, gestational diabetes and preterm delivery.

In addition, the results showed that most transgender men have prenatal care with physicians and deliver in hospitals; however, transgender men may seek medical care with nonphysician providers and deliver at nonhospital locations at higher rates than the general population — possibly due to previous negative experiences in traditional health care settings.

Brandt and colleagues also wrote that close monitoring and frequent assessments for worsening gender dysphoria, perinatal depression and suicidal ideation are vital for the obstetric care of transgender men. Educational resources and training opportunities are needed for healthcare providers to improve evidence-based provision of health care delivery for transgender individuals.

“We need more research, especially about the short-term and long-term impact of pregnancy on gender dysphoria,” Brandt told Healio Psychiatry. “Providers need more experience managing transgender men during pregnancy, and we hope our study may be a helpful resource.” – by Savannah Demko

Disclosure: The authors report no relevant financial disclosures.