Transgender pregnancy

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Transgender pregnancy is the gestation of one or more embryos or fetuses by transgender people. As of 2023, the possibility is restricted to those born with female reproductive systems. However, transition-related treatments may impact fertility. Transgender men and nonbinary people who are or wish to become pregnant face social, medical, legal, and psychological concerns. As uterus transplantations are currently experimental, and none have successfully been performed on trans women, they cannot become pregnant.

Contents

Trans men

Pregnant trans man Zack Elias and his transgender wife, Diane Rodriguez. Diane Rodriguez y Su esposo Zack Elias en alta resolucion.jpg
Pregnant trans man Zack Elías and his transgender wife, Diane Rodríguez.

Pregnancy is possible for transgender men who retain functioning ovaries and a uterus, such as in the case of Thomas Beatie. [1] Regardless of prior hormone replacement therapy (HRT) treatments, the progression of pregnancy and birthing procedures are typically the same as those of cisgender women. Delivery options include conventional methods such as vaginal delivery and cesarean section, and patient preference should be taken into consideration in order to reduce gender dysphoric feelings associated with certain physical changes and sensations. [2] It has been shown that historical HRT use may not negatively impact ovarian stimulation outcomes, with no significant differences in the markers of follicular function or oocyte maturity between transgender men with and without a history of testosterone use. [3]

Among the wide array of transgender-related therapies available, including surgical and medical interventions, some offer the option of preserving fertility while others may compromise one's ability to become pregnant (including bilateral salpingo-oophorectomy and/or total hysterectomy).

Effect of masculinizing hormone therapy

Exposing a fetus to high levels of exogenous testosterone may damage an unborn child, especially the urogenital system of a female fetus. [4] This is particularly important in the first trimester when many pregnancies have not been discovered yet. [5] Previous studies of pregnancies in women suggest that high levels of endogenous androgens are associated with reduced birth weight, although it is unclear how prior testosterone in a childbearing trans person may affect birth weight. [2] Future pregnancies can be achieved by oophyte banking, but the process may increase gender dysphoria or may not be accessible due to lack of insurance coverage. [6]

Additionally, patients experiencing amenorrhea (a common side effect of HRT) may experience additional challenges in identifying early pregnancies due to the lack of regular menstrual cycling that could indicate a pregnancy if missed, for example. [5] For this reason, it is important for patients and healthcare practitioners to comprehensively discuss fertility goals, family planning and contraceptive options during gender-affirming care. [5] Many trans men who had planned pregnancies were able to conceive within six months of stopping testosterone. [6] Testosterone-induced changes to the reproductive tract may be partly or completely reversed after stopping HRT.

HRT for trans men eventually decreases fertility. Continued use of testosterone suppresses the ovarian cycle and uterine cycle, which would otherwise cause oocyte maturation, ovulation, and menstruation every month. Testosterone therapy also causes atrophy of the vagina and uterus. [7] Testosterone use in trans men and other transmasculine individuals affects the ovaries, leading to an increased amount of ovarian cysts, which is also seen in cis women with PCOS. Individuals studied also displayed follicular atresia, overgrowth of the stroma, and the replacement of ovarian tissue with collagen. The uterine tubes of many trans men studied were also closed or partially closed; normally, the uterine tubes are clear, allowing for fertilized oocytes to move to the uterus. However, observation of trans men and studies on lab mice reveal that testosterone treatment does not affect the number of available gametes (eggs/sex cells). [8]

In a study of American trans men, 28.3% reported that they were afraid of not being able to become pregnant because of hormone therapy. Because some trans men want to carry children, it is important for providers to discuss fertility preservation options with trans male clients before prescribing HRT. [9]

Despite its effects on fertility, testosterone therapy is not an effective contraceptive. Trans men and nonbinary people who take testosterone may still become pregnant even if their periods have stopped. [2] [10] Trans men may experience unintended pregnancy, [6] [9] especially if they miss doses. [6]

Another important postpartum consideration for trans men is whether to resume testosterone therapy. There is currently no evidence that testosterone enters breast milk in a significant quantity. [11] However, elevated testosterone levels may suppress lactation and healthcare guidelines have previously recommended that trans men do not undergo testosterone therapy while chestfeeding (breastfeeding). [12] Trans men who undergo chest reconstruction surgery may maintain the ability to chestfeed. [13]

Mental health

Special consideration of the mental health of transgender people during pregnancy is important. It has previously been shown that transgender individuals often experience higher rates of suicidality than cisgender people and lesser degrees of social support from their environment and familial relationships. [14] [15] Relatedly, many transgender individuals experiencing pregnancy reported that choices of healthcare providers were substantially impacted by the views of the healthcare worker, and many transgender people prefer midwifery services rather than experience labor and delivery in a hospital.

Some individuals reported having gender dysphoria and feelings of isolation due to the public reception of their gender identity and drastic changes in appearance which occur during pregnancy, such as enlarged breasts. [16] Some state feeling disconnected or alienated from their pregnant bodies. Both social gender dysphoria (related to perception by others) and physical gender dysphoria (perception of one's own body) can occur while a trans person is pregnant. [17] [18]

Unintended pregnancy can also be dangerous to a trans person's mental health. According to a study of American transgender men between the ages of 18 and 45, 30.5% reported being afraid of pregnancy. [19] Unwanted pregnancy can cause severe gender dysphoria and suicidal ideation in trans people. One nonbinary person who performed a self-induced abortion stated, [20]

[I used] blunt force to [my] abdomen. Considered drinking poison, as my insurance did not cover an abortion. Luckily, I was able to get on state insurance which did cover the procedure, so it did not come to that. I 100% would have done it. Dying was a better alternative to forced pregnancy.

According to the National Transgender Discrimination Survey, postpartum rates of suicide and depression in trans individuals has been found to be higher than the adult average. [15] This may be attributed to factors such as lack of social support, discrimination, and lack of adequate healthcare practitioner training. [15]

Sociocultural factors

Transgender people, including trans men and nonbinary people, are more likely than the general population to experience homelessness, food insecurity, intimate partner violence, and adverse child experiences. All of these can impact pregnancy outcomes. Additionally, trans people experience minority stress and may be at higher risk of substance use than the general population. Some also report avoiding medical care or mistrusting medical professionals because of discrimination. [21]

Medical discrimination

Some trans men who carry pregnancies are subjected to discrimination, which can include a variety of negative social, emotional, and medical experiences, as pregnancy is regarded as an exclusively feminine or female activity. Several studies indicate a lack of awareness, services, and medical assistance available to pregnant trans men. [16] Inaccessibility to these services may lead to difficulty in finding comfortable and supportive services concerning prenatal care, as well as an increased risk for unsafe or unhealthy practices.

Abortion

Unintended pregnancies can result in transgender men or nonbinary people considering or attempting self-induced abortion. Many transgender men report attempting a self-induced abortion because of lack of safe, effective abortion methods. [20] Studies differ on abortion rates in trans men. Different studies report that between 12% [9] and 21% of trans people's pregnancies end in abortions. Some trans people report choosing between abortion and suicide because pregnancy causes terrible gender dysphoria. [20]

Statistics

According to figures compiled by Medicare for Australia, one of the few national surveys as of 2020, 75 male-identified people gave birth naturally or via C-section in the country in 2016, and 40 in 2017. [22]

Non-binary people

Non-binary people with a functioning female reproductive system can give birth. [23]

Nonbinary people taking testosterone to transition must interrupt HRT in order to carry the pregnancy, as testosterone is a teratogen. [4] Unintended pregnancies by non-binary people on testosterone therapy may be more common if they are on a low dose of testosterone. [6] Nonbinary parents choose whether to be called "mom," "dad," or newly coined gender-neutral or nonbinary titles. [24]

Non-binary people who have written or been profiled about their experiences of pregnancy include Rory Mickelson, [25] Braiden Schirtzinger, [26] and Mariah MacCarthy. [27]

Trans women

Lili Elbe in October 1930, a year before her death from a rejected uterus transplant Lili Elbe 1930.jpg
Lili Elbe in October 1930, a year before her death from a rejected uterus transplant

Pregnancy is not possible for transgender women as they lack a female reproductive system. As of 2019, uterus transplantation has not been successfully performed in transgender women. [28] The Danish transgender painter Lili Elbe died in 1931 from surgical complications following an attempt at such an operation.

Uterine transplantation, or UTx, is in its infancy and is not yet publicly available. As of 2019, in cisgender women, more than 42 UTx procedures had been performed, with 12 live births resulting from the transplanted uteri as of publication. [29] The International Society of Uterine Transplantation (ISUTx) was established internationally in 2016, with 70 clinical doctors and scientists, and currently has 140 intercontinental delegates. [30]

In 2012, McGill University published the "Montreal Criteria for the Ethical Feasibility of Uterine Transplantation", a proposed set of criteria for carrying out uterine transplants, in Transplant International. [31] Under these criteria, and because no research has been conducted in genetic males, only a genetic female could ethically be considered a transplant recipient. The exclusion of trans women from candidacy is justified by the lack of research to determine how to conduct the surgery, rather than an inherent bar. [32] In 2021, authors of the Montreal Criteria published a revised set of criteria in Bioethics with an ethical framework for consideration of genetic males' (and other genetic XY individuals') eligibility for uterine transplants. [33]

In 2020, Mikey Chanel, an intersex trans woman, allegedly managed to achieve pregnancy after being artificially fertilized following a diagnosis of persistent Müllerian duct syndrome. She was assigned male with XY chromosomes and external male reproductive organs, but discovered she had internal female reproductive organs after an X-ray, which diagnosed her with PMDS. [34] [35] [36] No further information was released. Since Chanel's announcement, many have suspected it to be a hoax, citing Chanel's inaccuracies of describing PMDS symptoms and her history of sensationalism and radical attempts at social media popularity. Chanel has since taken down her social media pages.

Society and culture

In 1583, an intersex person that had masculine gender expression reportedly became pregnant in Beaumaris, Wales. [37]

Unicode introduced "pregnant man" and "pregnant person" emojis in version 14.0, approved September 2021. [38] However, this came with some controversy, as some viewed it to be absurd. [39]

See also

Related Research Articles

Dilationand curettage (D&C) refers to the dilation of the cervix and surgical removal of sections and or layers of the lining of the uterus and or contents of the uterus such as an unwanted fetus, remains of a non viable fetus, retained placenta after birth or abortion as well as any abnormal tissue which may be in the uterus causing abnormal cycles by scraping and scooping (curettage). It is a gynecologic procedure used for treatment and removal as well as diagnostic and therapeutic purposes, and is the most commonly used method for First-Trimester Abortion or miscarriage.

Obstetrics and gynaecology is the medical specialty that encompasses the two subspecialties of obstetrics and gynaecology. The specialization is an important part of care for women's health.

<span class="mw-page-title-main">In vitro fertilisation</span> Assisted reproductive technology procedure

In vitro fertilisation (IVF) is a process of fertilisation where an egg is combined with sperm in vitro. The process involves monitoring and stimulating a woman's ovulatory process, removing an ovum or ova from their ovaries and letting a man's sperm fertilise them in a culture medium in a laboratory. After the fertilised egg (zygote) undergoes embryo culture for 2–6 days, it is transferred by catheter into the uterus, with the intention of establishing a successful pregnancy.

<span class="mw-page-title-main">Family planning</span> Planning when to have children

Family planning is the consideration of the number of children a person wishes to have, including the choice to have no children, and the age at which they wish to have them. Things that may play a role on family planning decisions include marital situation, career or work considerations, financial situations. If sexually active, family planning may involve the use of contraception and other techniques to control the timing of reproduction.

<span class="mw-page-title-main">Trans man</span> Man assigned female at birth

A trans man is a man who was assigned female at birth. Trans men have a male gender identity, and many trans men undergo medical and social transition to alter their appearance in a way that aligns with their gender identity or alleviates gender dysphoria.

<span class="mw-page-title-main">Male pregnancy</span> Pregnancy in males

Male pregnancy is the incubation of one or more embryos or fetuses by organisms of the male sex in some species. Most species that reproduce by sexual reproduction are heterogamous—females producing larger gametes (ova) and males producing smaller gametes (sperm). In nearly all animal species, offspring are carried by the female until birth, but in fish of the family Syngnathidae, males perform that function.

Male contraceptives, also known as male birth control, are methods of preventing pregnancy that are used by males or people who produce sperm. The main forms of male contraceptives available today are condoms, vasectomy, and withdrawal, and these methods combined make up less than one-third of global contraceptive use.

<span class="mw-page-title-main">Hormonal intrauterine device</span> Intrauterine device

A hormonal intrauterine device (IUD), also known as an intrauterine system (IUS) with progestogen and sold under the brand name Mirena among others, is an intrauterine device that releases a progestogenic hormonal agent such as levonorgestrel into the uterus. It is used for birth control, heavy menstrual periods, and to prevent excessive build of the lining of the uterus in those on estrogen replacement therapy. It is one of the most effective forms of birth control with a one-year failure rate around 0.2%. The device is placed in the uterus and lasts three to eight years. Fertility often returns quickly following removal.

<span class="mw-page-title-main">Sexual and reproductive health</span> State of the reproductive system without evidence of disease, disorders, or deficiencies

Sexual and reproductive health (SRH) is a field of research, health care, and social activism that explores the health of an individual's reproductive system and sexual well-being during all stages of their life. Sexual and reproductive health is more commonly defined as sexual and reproductive health and rights, to encompass individual agency to make choices about their sexual and reproductive lives.

Gender incongruence is the state of having a gender identity that does not correspond to one's sex assigned at birth. This is experienced by people who identify as transgender or transsexual, and often results in gender dysphoria. The causes of gender incongruence have been studied for decades.

A uterine transplant is a surgical procedure whereby a healthy uterus is transplanted into an organism of which the uterus is absent or diseased. As part of normal mammalian sexual reproduction, a diseased or absent uterus does not allow normal embryonic implantation, effectively rendering the female infertile. This phenomenon is known as absolute uterine factor infertility (AUFI). Uterine transplant is a potential treatment for this form of infertility.

Masculinizing hormone therapy, also known as transmasculine hormone therapy or female-to-male hormone therapy, is a form of hormone therapy and gender affirming therapy which is used to change the secondary sexual characteristics of transgender people from feminine or androgynous to masculine. It is a common type of transgender hormone therapy, and is predominantly used to treat transgender men and other transmasculine individuals who were assigned female at birth. Some intersex people also receive this form of therapy, either starting in childhood to confirm the assigned sex or later if the assignment proves to be incorrect.

Feminizing hormone therapy, also known as transfeminine hormone therapy, is hormone therapy and sex reassignment therapy to change the secondary sex characteristics of transgender people from masculine or androgynous to feminine. It is a common type of transgender hormone therapy and is used to treat transgender women and non-binary transfeminine individuals. Some, in particular intersex people, but also some non-transgender people, take this form of therapy according to their personal needs and preferences.

Female genital disease is a disorder of the structure or function of the female reproductive system that has a known cause and a distinctive group of symptoms, signs, or anatomical changes. The female reproductive system consists of the ovaries, fallopian tubes, uterus, vagina, and vulva. Female genital diseases can be classified by affected location or by type of disease, such as malformation, inflammation, or infection.

Transgender hormone therapy, also called hormone replacement therapy (HRT) or gender-affirming hormone therapy (GAHT), is a form of hormone therapy in which sex hormones and other hormonal medications are administered to transgender or gender nonconforming individuals for the purpose of more closely aligning their secondary sexual characteristics with their gender identity. This form of hormone therapy is given as one of two types, based on whether the goal of treatment is masculinization or feminization:

Transgender health care includes the prevention, diagnosis and treatment of physical and mental health conditions, as well as gender-affirming care, for transgender individuals. A major component of transgender health care is gender-affirming care, the medical aspect of gender transition. Questions implicated in transgender health care include gender variance, sex reassignment therapy, health risks, and access to healthcare for trans people in different countries around the world.

Menstrual suppression refers to the practice of using hormonal management to stop or reduce menstrual bleeding. In contrast to surgical options for this purpose, such as hysterectomy or endometrial ablation, hormonal methods to manipulate menstruation are reversible.

<span class="mw-page-title-main">Use of assisted reproductive technology by LGBT people</span>

Lesbian, gay, bisexual, and transgender people people wishing to have children may use assisted reproductive technology. In recent decades, developmental biologists have been researching and developing techniques to facilitate same-sex reproduction.

Discrimination against transgender men and transmasculine individuals, sometimes referred to as transandrophobia, anti-transmasculinity, or transmisandry, is a similar concept to transmisogyny and discrimination against non-binary people. Transmisogyny, discrimination against transgender men and discrimination against nonbinary people are types of transphobia which affect trans women, trans men and nonbinary people respectively.

Kayden Coleman is an American transgender advocate, educator, and social media influencer. He is known for raising awareness of transmasculine men who experience pregnancy. In 2013, when Coleman was 4 years into gender reassignment therapy, he found out he was pregnant with his and his partner's first child. Since then, Coleman has been interviewed by news outlets such as USA Today, TODAY.com, and Out about his experiences with transgender pregnancy. In 2021, he was honored by Out as an Out100 honoree, a recognition given to prominent members of the LGBTQ+ community for their outstanding work promoting LGBTQ+ rights. He has appeared in a commercial for Lexus.

References

  1. ↑ Beatie, Thomas (April 8, 2008). "Labor of Love: Is society ready for this pregnant husband?". The Advocate . p. 24.
  2. 1 2 3 Obedin-Maliver, Juno; Makadon, Harvey J (2016). "Transgender men and pregnancy". Obstetric Medicine. 9 (1): 4–8. doi:10.1177/1753495X15612658. PMC   4790470 . PMID   27030799.
  3. ↑ Adeleye, Amanda J.; Cedars, Marcelle I.; Smith, James; Mok-Lin, Evelyn (October 2019). "Ovarian stimulation for fertility preservation or family building in a cohort of transgender men". Journal of Assisted Reproduction and Genetics. 36 (10): 2155–2161. doi:10.1007/s10815-019-01558-y. PMC   6823342 . PMID   31435820.
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  8. ↑ Kinnear, Hadrian M.; Moravek, Molly B. (February 2023). "Effects of Masculinizing Therapy on Reproductive Capacity". In Moravek, Molly B.; de Haan, Gene (eds.). Reproduction in Transgender and Nonbinary Individuals. Springer Publishing. pp. 33–47. doi:10.1007/978-3-031-14933-7. ISBN   9783031149337.
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  17. ↑ Greenfield, Mari; Darwin, Zoe (2020). "Trans and non-binary pregnancy, traumatic birth, and perinatal mental health: a scoping review". International Journal of Transgender Health. 22 (1–2). Taylor & Francis: 203–216. doi:10.1080/26895269.2020.1841057. PMC   8040683 . PMID   34806082.
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  19. ↑ Light, Alexis; Wang, Lin-Fan; Zeymo, Alexander; Gomez-Lobo, Veronica (October 2018). "Family planning and contraception use in transgender men". Contraception. 98 (4): 266–269. doi:10.1016/j.contraception.2018.06.006. PMID   29944875. S2CID   49434157. Most participants were not afraid of pregnancy (n=130, 69.5%)
  20. 1 2 3 Moseson, Heidi; Fix, Laura; Gerdts, Caitlin; Ragosta, Sachiko; Hastings, Jen; Stoeffler, Ari; Goldberg, Eli A; Lunn, Mitchell R; Flentje, Annesa; Capriotti, Matthew R; Lubensky, Micah E; Obedin-Maliver, Juno (January 2022). "Abortion attempts without clinical supervision among transgender, nonbinary and gender-expansive people in the United States". BMJ Sexual & Reproductive Health. 48 (e1): e22–e30. doi:10.1136/bmjsrh-2020-200966. PMC   8685648 . PMID   33674348.
  21. ↑ Indig, Gnendy; Ramos, Sebastian; Stroumsa, Daphne (February 2023). "Obstetric, Antenatal, and Postpartum Care for Transgender and Nonbinary People". In Moravek, Molly B.; de Haan, Gene (eds.). Reproduction in Transgender and Nonbinary Individuals. Springer Publishing. pp. 75–96. doi:10.1007/978-3-031-14933-7. ISBN   9783031149337.
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  28. ↑ Cheng, Philip J.; Pastuszak, Alexander W.; Myers, Jeremy B.; Goodwin, Isak A.; Hotaling, James M. (June 2019). "Fertility concerns of the transgender patient". Translational Andrology and Urology. 8 (3): 209–218. doi: 10.21037/tau.2019.05.09 . PMC   6626312 . PMID   31380227.
  29. ↑ Jones, Bp; Williams, Nj; Saso, S; Thum, M-Y; Quiroga, I; Yazbek, J; Wilkinson, S; Ghaem-Maghami, S; Thomas, P; Smith, Jr (January 2019). "Uterine transplantation in transgender women". BJOG. 126 (2): 152–156. doi:10.1111/1471-0528.15438. PMC   6492192 . PMID   30125449. S2CID   52046974.
  30. ↑ "History of ISUTx". Archived from the original on 2021-11-23. Retrieved 2020-05-11.
  31. ↑ Lefkowitz, Ariel; Edwards, Marcel; Balayla, Jacques (2012). "The Montreal Criteria for the Ethical Feasibility of Uterine Transplantation". Transplant International. 25 (4): 439–47. doi:10.1111/j.1432-2277.2012.01438.x. PMID   22356169. S2CID   39516819.
  32. ↑ Lefkowitz, Ariel; Edwards, Marcel; Balayla, Jacques (October 2013). "Ethical considerations in the era of the uterine transplant: an update of the Montreal Criteria for the Ethical Feasibility of Uterine Transplantation". Fertility and Sterility. 100 (4): 924–926. doi: 10.1016/j.fertnstert.2013.05.026 . PMID   23768985. in the absence of sufficient research demonstrating safety and efficacy, uterine transplant in men and trans individuals fails to meet the first stipulation of Moore's Criteria for Surgical Innovation, which requires that novel surgical procedures have an adequate research background. It is on this basis that the Montreal Criteria exclude nongenetic female recipients. However, it certainly bears mentioning that there does not seem to be a prima facie ethical reason to reject the idea of performing uterine transplant on a male or trans patient. A male or trans patient wishing to gestate a child does not have a lesser claim to that desire than their female counterparts.
  33. ↑ Balayla J.; Pounds P.; Lasry A.; Volodarsky-Perel A.; Gil A. (2021). "The Montreal Criteria and uterine transplants in transgender women". Bioethics. 35 (4): 326–330. doi:10.1111/bioe.12832. PMID   33550647. S2CID   231862917.
  34. ↑ Cliff, Martha (November 17, 2020). "Teenager raised as a boy announces pregnancy after discovery of female reproductive organs".
  35. ↑ Agrawal, Saumya (November 18, 2020). "Trans teen who was raised as a boy is four months pregnant after finding she has ovaries and womb". Times Now News.
  36. ↑ "A teen who was born with male genitalia has become pregnant after finding out that she also has working ovaries, a uterus, cervix and fallopian tubes". Yahoo News. November 16, 2020.
  37. ↑ Hume, M.A.S. (2013). Calendar of Letters and State Papers Relating to English Affairs: Volume 3: Preserved Principally in the Archives of Simancas. Cambridge Library Collection - British and Irish History, 15. Cambridge University Press. p. 475. ISBN   978-1-108-06189-6. Archived from the original on 2022-10-25. Retrieved 2022-10-25.
  38. ↑ "Why is There a Pregnant Man Emoji?". 15 September 2021. Archived from the original on 28 January 2022. Retrieved 29 January 2022.
  39. ↑ "The pregnant man emoji and other absurdities". The Spectator Australia. May 12, 2022.
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