Reproductive Health Care for Trans People

“Currently, there is very little research data to inform trans people of their reproductive care and contraceptive choices.”

Now, Brayboy thinks it is time for the mandate to be re-evaluated, to make sure all genders are included. “There are an estimated 1.5 million trans people in the United States, but unfortunately there is really sparse data about transgender individuals across the field of reproduction—and even emerging research (such as a study on ovulation during testosterone therapy by Taub et al. which was published in 2020) concludes that further studies are needed,” says Brayboy. “It would be fantastic to see these studies being carried out, especially as they are vital to the advancement of proper reproductive health for trans people all over the world.”

Read: Sexual Health: Why It May Not Mean What You Think It Does (and That’s a Good Thing!)

Testosterone Therapy and Birth Control

For trans men, gender-affirming testosterone therapy is meant to produce desired, masculine characteristics such as a deeper voice or facial hair. Brayboy notes that one side effect of testosterone therapy, which is also sometimes considered a desirable outcome for trans men, is amenorrhea, or the absence of spontaneous periods.

However, Brayboy stresses an important detail—testosterone is not a contraceptive and people can become pregnant despite not having a period. “This means that reliable contraception is still very important for transgender men, even when taking testosterone—although it is sometimes a health issue which can be overlooked,” she says.

There is no clinical consensus on what the most appropriate contraceptive option is when it comes to the transition process. “It has been reported that no contraceptives are contraindicated, or unadvisable to use, for trans men,” says Brayboy. A very commonly prescribed method is the oral contraceptive pill. “Both components of the oral contraceptive pill (a synthetic estrogen called ethinyl estradiol and a synthetic progesterone called progestin) work independently to impede the production and effect of androgens (hormones associated with male characteristics, like testosterone and androstenedione) that are made naturally by the ovaries and adrenal glands. Therefore, there is a possibility combined oral birth control pills could negate the desired gender-affirming therapy for people assigned a female at birth who are now transitioning to male.”

Brayboy says there isn’t enough data to really know with certainty whether this is the case. “This is why we need further clinical research, and better enrollment of trans men in contraceptive studies in general: so we have more data.”

For example, one method of contraception that transgender men could consider could be progestin only methods, say Brayboy, as these have a singular impact on testosterone production (rather than the dual one that the combined pill has). She says they could also consider a hormonal intrauterine device (IUD): the progestin-only IUD (which uses the synthetic hormone levonorgestrel) has the benefit of at least 20% of users having amenorrhea.

Read: We Asked An Expert: Which Birth Control is Best?

“With the hormonal IUD, the hormone does circulate in the blood, but it has been reported to have a localized effect only in the uterus,” says Brayboy. “Finally, the etonogestrel progestin implant is the most effective form of birth control and many individuals experience infrequent bleeding or amenorrhea, but of course this implant, like the IUD, needs to be placed by a trained healthcare professional. Keep in mind that everyone is different so your bleeding profile could vary.”According to The Endocrine Society clinical practice guidelines, gender affirming hormone therapy has the same risk as sex hormone replacement in the non-transgender populations. “This means that taking hormones as a trans person is the same as a cis-gender person taking hormone replacement,” says Brayboy.However, Brayboy notes there are some possible issues that can arise when testosterone is overdosed. “These include an overproduction of red blood cells, sleep apnea, high blood pressure, excessive weight gain, salt retention, changes in blood cholesterol, liver disease and excessive or cystic acne. The medical adverse risks as a result of these changes include heart disease, a diagnosis of high blood pressure and breast/uterine cancer,” she says. “Therefore, those who are transitioning are advised by medical professionals – from both major European and American medical societies, as well as the World Professional Association for Transgender Health – to seek out the following kinds of screenings and care when it comes to reproductive care:”

Important Trans Health Care Screenings

  1. Prior to transitioning all individuals should be counseled and offered fertility preservation in case the individual would like to become pregnant in the future, according to the American Society for Reproductive Medicine. Clue offers a non-binary Pregnancy Tracker with Clue Plus.

  2. It’s recommended that in the first year, trans males be evaluated every 3 months for for possible adverse reaction of desired effects (such as deepening of voice, male pattern hair growth and clitoral enlargement); for measurement of testosterone levels; a blood count; weight; blood pressure and lipids will also need to be monitored.

  3. If a trans male has a cervix, regular pap smears will need to be done, according to the American College of Obstetricians and Gynecologists.

  4. If top surgery/mastectomy is done then annual chest/areolar examinations, If not, then mammograms, as recommended by the American Cancer Society.

  5. Discuss your reproductive life plan and contraceptive options with your healthcare provider.

  6. Track your bleeding and make sure to discuss any changes with your healthcare provider.

All people – no matter their gender, sex or identity – should be regularly screened for STIs and practice safe sex. More information on STI prevention can be found on the Clue website.

Read: Chemical Romance: How Hormones Affect Sex, Love and Relationships

The Bottom Line

“Transgender health issues are public health issues, and we need everyone’s help to address the reproductive health disparities that exist.”

We need to demand that the US healthcare system provide affirming, inclusive, and adequate care for transgender individuals. Brayboy urges people to petition governmental representatives and local health officials to fund and approve studies, such as the PRIDE study, and new ones that specifically study both fertility, pregnancy, and contraceptive options for transgender and/or nonbinary individuals. She says we can also direct our attention towards volunteering for trans reproductive justice initiatives, shaping medical education for medical trainees and health care professionals, and our own awareness of the increased violence against Black trans lives. “Transgender health issues are public health issues, and we need everyone’s help to address the reproductive health disparities that exist,” she says.

For more information on hormones, listen to Clue’s podcast, Hormonal, where each week, doctors, experts, and scientists, break it all down.

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Article Source : kinkly.com – Sex ed for adults! Kinkly provide reviews, education and perspectives to help you have sex that’s healthy, consensual and fun.

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