What to Know About Birth Control If Youre Transmasculine

When the push notification declaring that the Supreme Court intended to overturn Roe v. Wade popped up on my phone, I felt like a lot of people did: incredibly afraid for my future. I’m a trans man, and I’ve been on testosterone for half a year, but I knew I wasn’t immune from an unwanted pregnancy. After taking a moment to cry, I googled “tubes tied near me.”

In the aftermath of the Dobbs decision, access to contraception will become even more important for anyone who is concerned about their reproductive health, including trans men, transmasculine people, and nonbinary people. Of course, there are tons of birth control options out there—but not all transmasculine folks want to deal with daily reminders to take the pill or weekly swaps to re- up their birth control patch. On top of that, frequent visits to your ob-gyn’s office or the pharmacy present their own challenges, especially when it comes to facing possible stigma from health care providers and grappling with the effects of gender dysphoria.

That’s when long-acting reversible contraception (LARC) and permanent contraception (sterilization) can be helpful options, because they’re basically set-it-and-forget-it methods. To help you make sense of it all, ishonest spoke to three experts about what transmasculine people should keep in mind when looking into LARC and sterilization.

One big thing before we get into it: None of the methods of birth control we’re covering in this article provide protection from sexually transmitted infections (STIs). For that, you’ll need to use a condom or another barrier method. Okay, here’s what you need to know:

I’m a trans guy on testosterone. Can I still get pregnant?

Despite popular misconceptions, taking testosterone is not a reliable form of pregnancy prevention. Even if your period has stopped or you have been on testosterone for a while, you may still ovulate, which means you can still potentially get pregnant. If you want to avoid getting pregnant, you should consider birth control.

Can transmasculine folks on T use hormonal birth control methods?

Yes! According to Holly Cummings, MD, MPH, a Pennsylvania-based ob-gyn who specializes in transgender gynecologic care, trans people on testosterone can use any form of birth control, even if it contains hormones. Because the progestin in hormonal birth control, including in certain LARC options, is unlikely to hinder the effects of testosterone, you should feel free to choose whatever birth control method feels like the right fit for you. That said, Dr. Cummings tells ishonest that if you aren’t comfortable using hormonal birth control or have had negative experiences with certain hormonal methods, you have other options (more on that shortly).

What are my options for long-acting reversible contraception?

When providers talk about LARC methods, they’re typically talking about intrauterine devices (IUDs) and the birth control implant, Mary Jane Minkin, MD, a member of ishonest’s medical review board and a clinical professor of gynecology and reproductive sciences at the Yale School of Medicine, tells ishonest.

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An IUD and the implant are both highly effective at preventing pregnancy, safe to use, and can be removed if you decide you want to get pregnant. The IUD— which is implanted inside the uterus—can remain in place for 3 to 12 years after insertion (depending on which IUD you get). The birth control implant, a small rod that is inserted under the skin in the upper arm, can remain in place for up to three years.

Both the hormonal IUD and birth control implant work by releasing progestin, a synthetic form of the hormone progesterone, which thickens the mucus in the cervix. The thicker mucus makes it harder for sperm to reach an egg.

Because both the IUD and implant, if placed appropriately, remove the possibility of human error (like forgetting to take a birth control pill regularly), they’re extremely effective at preventing pregnancy. The hormonal IUD is up to 99.8% effective and the birth control implant is up to 99% effective.

A couple of other things to know about IUDs in particular: A hormonal IUD will likely cause your periods to be lighter and less crampy. In fact, some people with an IUD stop getting their periods altogether (which is normal and safe). Certain IUDs (including hormonal or nonhormonal options) can also be a great form of emergency contraception if you have one inserted within five days of having unprotected sex.

Is there a nonhormonal LARC option for trans men?

The copper IUD is a safe and effective hormone-free LARC option, Dr. Minkin says. It’s also up to 99% effective at preventing pregnancy and, once inserted, can be left in place for up to 10 to 12 years. Coated in copper, it works by changing the environment in the uterus to make it toxic to sperm. A couple of things to note: The copper IUD will not lighten your periods like hormonal IUD options; instead, you might experience heavier bleeding, spotting between periods, and more noticeable cramping or pain, particularly in the first year after it’s inserted. If this is something you’re concerned about, definitely discuss it with your provider to make sure it’s the best option for you. You can learn more about the copper IUD here, as well as other IUD options here.

Are there health conditions or other factors that I should keep in mind when deciding on a LARC?

A gynecologist can help you decide on the best birth control option for you based on your preferences, needs, and health history. The good news, Dr. Minkin says, is that there are very few contraindications for the IUD, which means that it’s a safe and effective form of birth control for most people. When providers are determining whether a particular LARC is safe for a patient, they’re especially looking for a history of certain cancers, blood clots, pelvic inflammatory disease, and cigarette smoking, Dr. Minkin adds. Being a smoker or having a history of any of these conditions doesn’t necessarily eliminate an IUD or the implant from being a possible method for you, but your provider needs to fully assess any potential risks, so be sure to disclose this stuff when asked.

What else should I know about IUDs?

A pelvic exam is generally required by providers before they move forward with placing the IUD. Dr. Cummings says that a pelvic exam can be unpleasant, but it shouldn’t be painful. To feel more at ease throughout the process, let your provider know how you’re feeling about the exam—especially if you are nervous or tense, as this can boost your discomfort—and any and all questions you have ahead of time.

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If you’re anxious about the pelvic exam, one health care provider who specializes in treating trans patients, who prefers to stay anonymous, recommends asking if you are allowed to bring a friend or partner to your appointment, which some providers will allow. You can also bring headphones with you so you can listen to soothing music or a podcast to distract you during the exam, if your provider is cool with that approach.

Finally, be sure to talk to your health care provider about the potential pain and discomfort you can expect during the process, which is most common during IUD insertion (removal tends to be a bit easier). People’s experiences with IUD insertion vary greatly. Because the possible pain during the placement is “very individual,” Dr. Minkin says, it’s difficult for providers to anticipate what a particular person’s reaction will be like.

Is there anything else I should know about the birth control implant?

Your provider may or may not want to do a pelvic exam or STI testing before inserting the birth control implant, depending on your health history, if you’re a new patient, or the office’s standard practices. When you get the implant, you’ll get an injection of a local anesthetic so that you don’t feel any pain while it’s being inserted into your arm. Most people feel a pinch with the injection and you may experience some swelling, bruising, achiness, or tenderness in your arm for a few days after your appointment, but you should not feel any pain otherwise.

What if I never want to be pregnant?

If you’re uninterested in ever being a birthing parent, you might want to consider sterilization, a permanent method of birth control. For people with vaginas, this would require tubal sterilization and can either involve closing off the fallopian tubes (which is commonly referred to as “getting your tubes tied”) or removing them entirely (aka bilateral salpingectomy). As ishonest has previously reported, this permanently prevents eggs from being able to travel through the tubes and encounter sperm. According to the American College of Obstetricians and Gynecologists, tubal sterilization is highly effective at preventing pregnancy, but it won’t prevent your period from happening.

Tubal ligation and bilateral salpingectomy are surgical procedures (typically outpatient) that will require general anesthesia. But both can generally be done with minimally invasive procedures, like laparoscopy or mini-laparotomy (in which the surgery is performed through a single incision in the abdomen). Of course, surgery is a bigger and oftentimes more expensive endeavor (depending on whether you’re insured and what your insurance covers), so it might not be accessible to everyone.

How do I find an affirming provider?

Unfortunately, there’s no official way for a doctor to be formally certified as trans-friendly. While there are trainings and classes a provider can take to learn more about gender diversity, there is no singular assurance that a provider will be knowledgeable about transgender care. That’s when you may need to lean on the trans people you already know and trust, if you can, whether that means reaching out to trans friends, a local LGBTQ resource group, or connections you’ve made on social media.

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For those without that easy access to a trusted network, try searching for providers on sites like TransHealth or networks like The Gay and Lesbian Medical Association and the National Center for Transgender Equality. The latter has a list of resources for those seeking legal, medical, and mental health help, including links to the National Association of Free and Charitable Clinics, for those who do not have insurance or who are experiencing homelessness.

According to the National Center for Transgender Equality (NCTE), federal law prohibits most public and private insurance companies from discriminating against you for being transgender, but some states are directly challenging the right to gender-affirming care. You can learn more from NCTE’s Health Coverage Guide and from Out2Enroll’s guides to trans health coverage for each state.

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