Trans men (men who have a uterus)
Can I get pregnant?
If you have a uterus and ovaries and ever have sex with some one who has sperm, you can get pregnant. This is true even if you are taking testosterone and don’t get periods.
What kind of birth control can I use if I take testosterone?
We don’t recommend contraceptive methods with estrogen. The best birth control methods are IUDs. Copper IUDs have no hormones and many trans men like these, but they can cause uterine cramps and bleeding. Hormonal IUDs have only a small amount of progesterone and this does not interfere with testosterone and rarely causes other hormonal side effects (like mood changes weight gain). One of the benefits is that most people lose their periods completely (even if not on testosterone).
Other contraceptives that work well and don’t interfere with testosterone are the injections every three months (DepoProvera), implants (Nexplanon, not available in Canada until next year) and progesterone pills (Micronor). These usually take periods away, but contain more progesterone than the hormonal IUDs and therefore have more side effects.
And, of course, there are condoms that protect against sexually transmitted infections as well as pregnancy. Pulling out (not ejaculating inside) reduces risk of pregnancy but is not enough.
How can I get rid of my periods?
The best method is the hormonal IUD (Mirena). It has only a small amount of progesterone and yet it works better to prevent periods than the progesterone injections (DepoProvera) or progesterone pills. If you are sure you never want to have children, you could ask for a hysterectomy, but that is major surgery with other risks.
Do I need Pap tests?
If you have a cervix, are between 25 and 69 years old and have ever had sex with a person of any gender, you are at risk of HPV related cancer of the cervix and should have a Pap test. Pap tests involve taking a sample from the cervix and sending it to a lab. If the test is normal, then it should be repeated every 3 years. If it is abnormal, it may mean that you have changes on the cervix that are precancerous and should be treated before they cause harm. It takes years for HPV to cause cancer, so regular Pap tests can prevent it. It is best to schedule your pap test just before your next testosterone injection.
Should I get the HPV vaccine?
YES! – The vaccine helps protect you against cervical cancer.
Sherbourne Health Centre in Toronto used to have information at a website called: www.checkitoutguys.ca/ with tips for vag exams that are trans sensitive, but it was focused on PAPs and not pregnancy. The page is now gone, but the General Website is here, and the CheckItOutGuys Facebook Page is here.
More research needed:
https://www.sciencedirect.com/science/article/abs/pii/S0010782418302221 — IUDs used more in men taking testosterone (30 participants, self-selected, survey) Oct 2018
Use of Copper Intrauterine Device in Transgender Male Adolescents:
https://www.contraceptionjournal.org/article/S0010-7824(18)30072-6/fulltext – July 2018
Contraception Choices for
https://srh.bmj.com/content/43/3/239.2 – 2017