Nearly 50% of transgender, gender-diverse people use contraception to prevent pregnancy

Key takeaways:

• Most transgender men reported ever using contraception, but only half used it to prevent pregnancy.
• About 10% of respondents relied on testosterone to prevent pregnancy, despite lack of efficacy evidence.

Most transgender and gender-diverse people assigned female at birth utilized contraception with nearly half using it for pregnancy prevention and some using testosterone as pregnancy prevention, researchers reported in Contraception.

“To inform equitable, evidence-based contraceptive counseling and shared decision-making with transgender and gender-diverse individuals, data are needed on contraceptive use, experiences and rationale for use among transgender and gender-diverse individuals who do and do not use testosterone,” Juno Obedin-Maliver, MD, MPH, MAS, FACOG, an obstetrician-gynecologist at Stanford University School of Medicine, and colleagues wrote.

Obedin-Maliver and colleagues evaluated data from a cross-sectional, online survey conducted in 2019 of 1,694 transgender and gender-diverse people (median age, 27 years) who were assigned female at birth. Researchers characterized current and ever use of contraceptive methods to prevent pregnancy and stratified by testosterone use.

Overall, 71% of respondents had previously used contraception, of whom 49.4% used contraception to prevent pregnancy.

Pregnancy prevention methods most used among respondents at any time were external condoms (91.8%), combined hormonal contraceptive pills (63%) and withdrawal (45.9%). In addition, respondents reported that external condoms (35.4%), hormonal IUD (24.8%) and abstinence (19.2%) were the most used pregnancy prevention methods currently used.

Twenty-seven percent of respondents reported never using contraception. Not engaging in penis-in-vagina sex (5.7%) or no sex with individuals who produce sperm (4.8%) were the most reported reasons for not using contraception.

Regarding testosterone, 72.3% of respondents had never used it, 8.2% reported prior use and 19.5% reported current use. Overall, 6.6% reported formerly and 3.6% reported currently relying on testosterone to prevent pregnancy, despite lack of efficacy data.

Participants who reported ever using testosterone had lower odds of currently using

combined hormonal contraceptive pills, patch or ring for pregnancy prevention than did those who never used testosterone (adjusted OR = 0.11; 95% CI, 0.03-0.45), according to the researchers.

Contraceptive use reasons were similar among testosterone ever vs. never users, except for avoiding period symptoms (34.8% vs. 40.7%; P = .02) and preventing hair growth (1.3% vs. 3.3%; P = .02).

“These data serve as both a proof of principle and a date-stamped backdrop against which more contemporary data from a post-Dobbs landscape with severely restricted care and education will be compared,” the researchers wrote. “Future research is needed to explore how the desire for or receipt of gender-affirming processes influences contraceptive decision-making, contraceptive outcomes and gender-affirming goals.”