#posted on February 13 2012 by TheArtOfTransliness

[frameacloud]

The above is a good post. Here are some additions.

T is not a form of birth control at all. The book Trans Bodies, Trans Selves is the most thorough and up-to-date book about transgender health written by trans people together with health professionals. It says,

"One of the most important things to remember is that testosterone is NOT birth control. In some of us assigned female at birth testosterone may decrease fertility, but this is not reliable and has not been tested clinically. Unintended pregnancy has occurred in [people] on testosterone for gender affirming hormone therapy."

- Laura Erickson-Schroth, ed. Trans Bodies, Trans Selves, 2nd edition, p. 594.

It's inadvisable to for someone to take T while pregnant or trying to get pregnant, and for many people T can temporarily pause their menstrual cycle as long as they're on it, but T does not prevent pregnancy by itself. If someone is on T and doesn't want to get pregnant, they need to also use some form of contraception. Many options for it won't interfere with T.

Some forms of hormonal contraception are compatible with being on T. In the years since the above post was written in 2012, Planned Parenthood's website and other resources have become much more inclusive of people who are transgender, so they have some good advice about this stuff. Planned Parenthood advises that if someone on T wants to add a hormonal form of contraception that won't interfere with T, "There are quite a few hormonal birth control options that don’t contain estrogen. These 'progestin-only' methods include: the implant (Implanon or Nexplanon), hormonal IUDs (Mirena, Skyla, and Liletta), the shot (Depo Provera), and even some kinds of birth control pills." Depending on which kind they are, these vary from 93% to more than 99% effective at preventing pregnancy. A person can also ask their health provider about using these to pause your menstrual cycle, if they're someone who finds that T doesn't do that for them by itself. (By the way, trans people who only want to pause their periods and don't want masculinization can ask about using birth control to do that without using T.)

Emergency contraception. If someone had sex without contraception, they can use emergency contraception within a few days afterward (the time limit depends on the exact method) to stop a pregnancy from being able to start. It's not an abortion, because the pregnancy doesn't start in the first place. Other than the copper intra-uterine device (which is the aforementioned non-hormonal IUD), the FSRH says that emergency contraception pills are compatible with being on T. Planned Parenthood has more info about these pills for people on T.

Permanent contraception. If someone on T never wants to get pregnant ever, they can get a procedure for permanent sterility: tubal ligation (having your "tubes tied"), or vasectomy for their partner, which are each almost 100% effective at preventing pregnancy. Hysterectomy (removing the uterus) is almost 100% effective at preventing pregnancy, or genuinely 100% effective if they also remove the ovaries and/or cervix.

Detecting a pregnancy while on T. If someone does unexpectedly get pregnant while on T, "those of us on testosterone often do not menstruate, so unintended pregnancy may be detected later in the course of the pregnancy because there is no missed menstrual period to alert us that we are pregnant" (Trans Bodies, Trans Selves, p. 594). If someone on T is wondering if they got pregnant, Planned Parenthood says an at-home pregnancy test will work okay, and trans hormone therapy won't interfere with it.

For people on T who want to have a baby: Testosterone doesn't permanently cause infertility. Pregnancy has been very well documented in trans people who had been on T, or had previously been on T, even if they weren't using any help for fertility (Light et al, 2014). Trans people temporarily take a break from being on T while pregnant or trying to get pregnant to make sure it will go okay. While off T, their menstrual cycle and fertility return, and they can have a baby as successfully as they would have. Famously, this is how Thomas Beatie had his children. He wasn't really the first man to do it, but he's the best-known. (Wikipedia's not a reliable source, but this is a good enough overview about this famous person.) The FDA warns that being on T while pregnant is known to be harmful to the developing fetus (Trans Bodies, Trans Selves, p. 594). The paper insert that your pharmacy gives you with your prescribed T gives this warning, too. The FSRH explains that being on T while pregnant can masculinize the fetus. That's if the person on T is the one who carries the pregnancy, though. The Gender Analysis blog talks about how if someone on T wants to freeze or donate eggs, they can pause taking T for a short amount of time. The process is no different than it is for anyone who freezes or donates their eggs. There have been a couple of studies where trans men who didn't even stop taking T have successfully been able to donate eggs to their partner, who carried the pregnancy successfully.

Some more resources about safer sex and contraception for trans men and trans masculine people.

The Faculty of Sexual and Reproductive Healthcare of the Royal College of Obstetricians and Gynaecologists (FSRH) has a document about contraceptive options for trans people.

(Warning: this next link has content that's more explicit than most sex education materials about safer sex.) The Gay Men's Sexual Alliance created the queer sex ed booklet "Primed: The Back Pocket Guide for Trans Men and the Men Who Dig Them," which has relevant precautions and tips to know if you're having sex with cisgender men.

"Check It Out, Guys" is about Pap tests for trans men. It has resources for ordinary trans men, as well as for their providers. If you're sexually active and have a cervix, then you need Paps to check for sexually transmitted infections that could cause cancer for you or your partners.

The Terrence Higgins Trust has a section with a bunch of great articles on safer sex and sexual health for trans men and trans masculine people.

Safer Sex and Contraception for Trans Guys

A lot of us are less than well-informed about how to have safe sex and prevent pregnancy as trans guys, partially because there isn’t a lot of information out there specifically for us. 

-For oral sex involving vulvas (vulvae?), a good way to reduce the chance of STI transmission is to use dental dams. These can be purchased at sex shops and similar locations or created using saran wrap, condoms, latex gloves, or other materials. They are also sometimes available for free or very cheap at university health centers, Planned Parenthoods, and LGBTQ resource centers. 

-If you’re using a prosthetic/dildo for vaginal, oral, or anal sex, it is important to make sure the materials it is made of are safe and that it is kept clean. Certain materials are more likely to grow bacteria than others, and certain materials contain phthalates, which are chemicals used to soften PVC and may be dangerous (a good rule of thumb to tell if a prosthetic contains phthalates is if it has a greasy texture and/or smells strongly of plastic). Prosthetics that are labeled non-porous and phthalate-free are generally safer, but that doesn’t let you off the hook for regular cleaning. Different materials require different cleaning methods, and so it’s good to do your research. If you are unsure if your prosthetic is clean and free of harmful chemicals, using a condom can help make things a bit safer for your partner. As a side note, if you suspect that your packer may contain harmful chemicals, you may want to wear it so it is not directly against your skin (for instance over your underwear or in its own little sock). 

-Testosterone may stop you from ovulating, but it probably isn’t a good idea to use it as your only form of birth control. Hormonal birth control while on testosterone is not really an option, so the pill, patch, and shot are out. However, condoms, diaphragms, and non-hormonal IUDs are still effective options for guys on T (this is not a complete list of all methods, and not all methods are created equal, look up effectiveness and weigh the pros and cons of each method). Hormonal birth control is fine for guys who are not on testosterone, although many trans* guys are uncomfortable with some of the “feminizing” effects hormonal birth control may have (for example, breast enlargement or breast tenderness). 

For more information on safer sex and contraception, check out Planned Parenthood’s website (unfortunately pretty much geared toward cis people but still pretty helpful), MegaThatcher’s video on Safe Sex for Trans Guys, and Queertransmen.org.