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. 2025 Jan:141:110719.
doi: 10.1016/j.contraception.2024.110719. Epub 2024 Sep 26.

Contraceptive use among transgender men and gender diverse individuals in the United States: Reasons for use, non-use, and methods used for pregnancy prevention

Juno Obedin-Maliver  1 , Ava Snow  2 , Sachiko Ragosta  3 , Laura Fix  3 , Jen Hastings  4 , Micah E Lubensky  5 , Matthew R Capriotti  6 , Zubin Dastur  7 , Annesa Flentje  8 , Mitchell R Lunn  9 , Heidi Moseson  10
Affiliations

Contraceptive use among transgender men and gender diverse individuals in the United States: Reasons for use, non-use, and methods used for pregnancy prevention

Juno Obedin-Maliver et al. Contraception. 2025 Jan.

Abstract

Objectives: To describe contraceptive use for pregnancy prevention among transgender men and gender diverse (TGD) individuals assigned female or intersex at birth (AFIAB) and explore whether contraceptive use differs by testosterone use.

Study design: We analyzed data from a cross-sectional, online survey of N = 1694 TGD individuals AFIAB recruited in 2019 through a community-facing website and a national community-engaged cohort study of sexual and/or gender minority (SGM) adults in the US. Descriptive and regression analyses characterized the current and ever use of contraceptive methods for pregnancy prevention, stratified by testosterone use, and described reasons for contraceptive use/non-use.

Results: Most respondents (71.0%) had used contraception before with 49.4% using it for pregnancy prevention. The methods that were most frequently ever used for pregnancy prevention included: external condoms (91.8%), combined hormonal contraceptive pills (63.0%), and withdrawal (45.9%). The methods most frequently currently used for pregnancy prevention included: external condoms (35.4%), hormonal intrauterine device (IUD) (24.8%), and abstinence (19.2%). Some reported formerly (n = 55, 6.6%) or currently (n = 30, 3.6%) relying on testosterone for pregnancy prevention. Only four of the 33 reasons for contraceptive use and non-use differed by testosterone use group. The most reported reasons for never using contraception were not engaging in penis-in-vagina sex (5.7%) or no sex with individuals who produce sperm (4.8%).

Conclusions: Most TGD individuals AFIAB have used contraception, and almost half for pregnancy prevention. The most used methods require minimal and/or non-invasive healthcare system interaction. Some respondents relied on testosterone as birth control, despite a lack of efficacy evidence.

Implications: TGD individuals use a range of birth control methods for pregnancy prevention and clinicians should not assume preferences for certain forms of contraception based on gender identity (e.g., estrogen avoidance). Clinicians should engage in patient-centered counseling and shared decision-making to provide high-quality contraceptive care to patients of all genders.

Keywords: Contraception; Gender minority; Nonbinary; Pregnancy prevention; Testosterone; Transgender.

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Conflict of interest statement

☆ Conflicts of interest: Dr. Mitchell Lunn has consulted for Hims, Incorporated (2019–present), Folx, Incorporated (2020), Otsuka Pharmaceutical Development and Commercialization, Incorporated (2023), and the American Dental Association (2024) for work unrelated to this study. Dr. Juno Obedin-Maliver has consulted for Sage Therapeutics (2017), Ibis Reproductive Health (2017–2018, 2020–present), Hims, Incorporated (2019–present), Folx, Incorporated (2019–present), and Upstream Incorporate (2024). Dr. Capriotti is on the clinical advisory board of Appa Health. None of these engagements influenced or are pertinent to the work described in this manuscript. None of these engagements influenced or are pertinent to the work described in this manuscript.

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References

    1. Moseson H, Fix L, Hastings J, Stoeffler A, Lunn MR, Flentje A, et al. Pregnancy intentions and outcomes among transgender, nonbinary, and gender-expansive people assigned female or intersex at birth in the United States: results from a national, quantitative survey. Int J Transgender Health [Internet] 2021;22(1–2):30–41. [cited Sep 14, 2021]. (https://www.tandfonline.com/doi/full/10.1080/26895269.2020.1841058). - DOI - PMC - PubMed
    1. Light A, Wang LF, Zeymo A, Gomez-Lobo V. Family planning and contraception use in transgender men. Contraception [Internet] 2018;98(4):266–9(https://pubmed.ncbi.nlm.nih.gov/29944875/). - PubMed
    1. Light AD, Obedin-Maliver J, Sevelius JM, Kerns JL. Transgender men who experienced pregnancy after female-to-male gender transitioning. Obstet Gynecol 2014;124(6):1120–7. - PubMed
    1. Porsch LM, Dayananda I, Dean G. An exploratory study of transgender New Yorkers’ use of sexual health services and interest in receiving services at planned parenthood of New York City. Transgender Health [Internet] 2016;1(1):231–7. [cited Apr 18, 2023]. (http://www.liebertpub.com/doi/10.1089/trgh.2016.0032). - DOI - PMC - PubMed
    1. Kanj RV, Conard LAE, Corathers SD, Trotman GE. Hormonal contraceptive choices in a clinic-based series of transgender adolescents and young adults. IInt J Transgend Health [Internet] 2019;20(4):413–20. [cited Apr 18, 2023]. (https://www.tandfonline.com/doi/full/10.1080/15532739.2019.1631929). - DOI - PMC - PubMed