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Contraceptive Pearls: Contraceptive Counseling For Transgender and Gender Diverse People

Creating a supportive, safe, and welcoming clinic environment can help reduce the barriers transgender and gender diverse individuals face when accessing reproductive health care.

It is vital to understand the contraceptive needs, fertility, and reproductive goals of each individual when providing contraceptive counseling. Gender-affirming testosterone therapy alone does not prevent pregnancy.

We do not know whether or not estrogen-containing contraceptives interfere with the masculinizing effects of testosterone therapy. Nor do we know the degree of thromboembolism risk of estrogen for patients on testosterone. Many transgender people taking testosterone prefer to avoid estrogen-containing contraceptives.

Progestin-only contraceptives can be used in transgender and gender diverse patients on testosterone therapy, both to prevent pregnancy and to limit bleeding and dysmenorrhea. We do not know whether progestin-only contraception alters or affects gender affirming testosterone therapy.

Non-hormonal contraceptives include the copper IUD, external/internal condoms, spermicide, and fertility awareness methods. None of these interact with testosterone. Patients who are amenorrheic on testosterone therapy are unlikely to experience significant bleeding after insertion of a copper IUD.



RHAP Birth Control Across the Gender Spectrum Fact Sheet



Bonnington A, Dianat S, Kerns J, Hastings J, Hawkins M, De Haan G, Obedin-Maliver J. Society of Family Planning clinical recommendations: Contraceptive counseling for transgender and gender diverse people who were assigned female sex at birth. Contraception. 2020 Aug;102(2):70-82. doi: 10.1016/j.contraception.2020.04.001. 

Contraceptive Pearls

This monthly clinical e-newsletter highlights evidence-based best practice for contraceptive care

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