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Grindlay K, Obedin-Maliver J, Ragosta S, Hastings J, Lunn MR, Flentje A, Capriotti MR, Dastur Z, Lubensky ME, Moseson H. Interest in over-the-counter progestin-only pills among transgender, nonbinary, and gender-expansive individuals in the United States. Am J Obstet Gynecol 2024; 230:657.e1-657.e17. [PMID: 38365096 PMCID: PMC11139560 DOI: 10.1016/j.ajog.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 01/31/2024] [Accepted: 02/09/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND In July 2023, the US Food and Drug Administration approved the first nonprescription oral contraceptive, a progestin-only pill, in the United States. Transgender, nonbinary, and gender-expansive people assigned female or intersex at birth face substantial contraceptive access barriers and may benefit from over-the-counter oral contraceptive access. However, no previous research has explored their perspectives on this topic. OBJECTIVE This study aimed to measure interest in over-the-counter progestin-only pill use among transgender, nonbinary, and gender-expansive individuals assigned female or intersex at birth. STUDY DESIGN We conducted an online, cross-sectional survey from May to September 2019 (before the US Food and Drug Administration approval of a progestin-only pill) among a convenience sample of transgender, nonbinary, and gender-expansive people assigned female or intersex at birth who were aged 18 to 49 years from across the United States. Using descriptive statistics and logistic regression analyses, we estimated interest in over-the-counter progestin-only pill use (our outcome) overall and by sociodemographic and reproductive health characteristics (our exposures). We evaluated separate logistic regression models for each exposure. In each model, we included the minimally sufficient adjustment set to control for confounding pathways between the exposure and outcome. For the model for age, we ran a univariable logistic regression model; for all other exposures, we ran multivariable logistic regression models. RESULTS Among 1415 participants in our sample (median age, 26 years), 45.0% (636/1415; 95% confidence interval, 42.3-47.6) were interested in over-the-counter progestin-only pill use. In separate logistic regression models for each exposure, there were higher odds of interest among participants who were aged 18 to 24 years (odds ratio, 1.67; 95% confidence interval, 1.33-2.10; vs those aged 25-34 years), those who were uninsured (adjusted odds ratio, 1.91; 95% confidence interval, 1.24-2.93; vs insured), those who currently used oral contraceptives (adjusted odds ratio, 1.69; 95% confidence interval, 1.17-2.44; vs non-users), had ≤high school degree (adjusted odds ratio, 3.02; 95% confidence interval, 1.94-4.71; vs college degree), had ever used progestin-only pills (adjusted odds ratio, 2.32; 95% confidence interval, 1.70-3.17; vs never users), and who wanted to avoid estrogen generally (adjusted odds ratio, 1.32; 95% confidence interval, 1.04-1.67; vs those who did not want to avoid estrogen generally) or specifically because they viewed it as a feminizing hormone (adjusted odds ratio, 1.72; 95% confidence interval, 1.36-2.19; vs those who did not want to avoid estrogen because they viewed it as a feminizing hormone). There were lower odds of interest among participants with a graduate or professional degree (adjusted odds ratio, 0.70; 95% confidence interval, 0.51-0.96; vs college degree), those who were sterilized (adjusted odds ratio, 0.31; 95% confidence interval, 0.12-0.79; vs not sterilized), and those who had ever used testosterone for gender affirmation (adjusted odds ratio, 0.72; 95% confidence interval, 0.57-0.90; vs never users). CONCLUSION Transgender, nonbinary, and gender-expansive individuals were interested in over-the-counter progestin-only pill use, and its availability has the potential to improve contraceptive access for this population.
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Affiliation(s)
| | - Juno Obedin-Maliver
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA; Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA; The PRIDE Study/PRIDEnet, Stanford University, Palo Alto, CA
| | | | - Jen Hastings
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA
| | - Mitchell R Lunn
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA; The PRIDE Study/PRIDEnet, Stanford University, Palo Alto, CA; Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Annesa Flentje
- The PRIDE Study/PRIDEnet, Stanford University, Palo Alto, CA; Department of Community Health Systems, University of California, San Francisco, San Francisco, CA; Alliance Health Project, Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA
| | - Matthew R Capriotti
- The PRIDE Study/PRIDEnet, Stanford University, Palo Alto, CA; Department of Psychology, San José State University, San Jose, CA
| | - Zubin Dastur
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA; The PRIDE Study/PRIDEnet, Stanford University, Palo Alto, CA
| | - Micah E Lubensky
- The PRIDE Study/PRIDEnet, Stanford University, Palo Alto, CA; Department of Community Health Systems, University of California, San Francisco, San Francisco, CA
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Vaccaro CJ, Karageuzian SA, McFadden E. The Importance of Safely Prescribing Hormones in the Transgender Community. Cureus 2023; 15:e44639. [PMID: 37799231 PMCID: PMC10548402 DOI: 10.7759/cureus.44639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2023] [Indexed: 10/07/2023] Open
Abstract
The transgender community is rapidly growing, necessitating further education and understanding of their unique healthcare needs. Gender affirmation is a multistep process, which generally begins with transgender individuals socially transitioning by adopting a new name, pronouns, and appearance changes, such as hair and clothing, to express themselves. Additional gender affirmation treatment can be achieved through medical therapy with hormones and surgical intervention. Here, we report the case of an 18-year-old transgender man who presented to his primary care provider for a referral to initiate a medical transition with testosterone therapy. The patient practiced penetrative vaginal sex without contraception. The patient presented to the clinic eight months later with amenorrhea, thick coarse facial and body hair, oily skin, irritable moods, and a 20-lb weight gain. A pregnancy test revealed a positive result. A healthy baby girl was delivered at 40 weeks' gestation. This case demonstrates the importance of addressing contraception during the masculinization process in individuals who continue to practice vaginal intercourse. Healthcare providers should seek to establish a clinical environment free of discrimination and stigma to allow patients to feel comfortable describing potential triggers of gender dysphoria. We encourage medical practitioners to discuss all methods of birth control with transgender male patients and choose the contraceptive that best allows for a seamless medical transition.
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Affiliation(s)
| | - Sergio A Karageuzian
- School of Osteopathic Medicine, A.T. Still University of Health Sciences, Mesa, USA
| | - Erin McFadden
- Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, USA
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Rivest P. La santé sexuelle des hommes trans : entre problèmes de catégorisation et invisibilisation. SANTE PUBLIQUE (VANDOEUVRE-LES-NANCY, FRANCE) 2023; 34:37-48. [PMID: 37336746 DOI: 10.3917/spub.hs2.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
INTRODUCTION Sexual minorities have been disproportionally impacted by the HIV-Aids epidemic. Their high prevalence motivated sexual health research that first focused on gay men, then trans women. Trans men have been considered at very low risk of exposition, Hence the scarce number of research about them. However, an emerging literature is showing diversified and surprising results regarding the reasons for their initial exclusion. PURPOSE OF RESEARCH This article seeks to establish the state of knowledge on trans men's sexual health through a French and international literature review. RESULTS Trans men have a variety of partners, sexual and non-sexual practices (IDU) that leads to categorize them at high risk of HIV exposure. The proportion of trans men who are HIV positive still is difficult to assess. It is estimated to be high in the USA, and close to zero in France. Low screening rates, difficulties accessing health care, and identification problems in the very classification of people suggest that they might be more of them. Trans men also report discriminations in access to health care services, and specific health vulnerabilities. Gynecology and reproductive health are rarely even mentioned. CONCLUSIONS Rethinking the categories used in research would produce a more accurate representation of the varied realities of trans people.
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Affiliation(s)
- Paul Rivest
- Institut d’ethnologie méditerranéenne, européenne et comparative (Idemec) – Aix-Marseille Université – Aix-en-Provence – France
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Okano SHP, Pellicciotta GGM, Braga GC. Contraceptive Counseling for the Transgender Patient Assigned Female at Birth. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:884-890. [PMID: 35793692 PMCID: PMC9948521 DOI: 10.1055/s-0042-1751063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Although almost 0.7% of the Brazilian population identifies as transgender, there is currently no training for healthcare professionals to provide comprehensive care to these patients, including the discussion of reproductive planning. The use of testosterone promotes amenorrhea in the first months of use; however, this effect does not guarantee contraceptive efficacy, and, consequently, increases the risks of unplanned pregnancy. The present article is an integrative review with the objective of evaluating and organizing the approach of contraceptive counseling for the transgender population who were assigned female at birth. We used the PubMed and Embase databases for our search, as well as international guidelines on care for the transgender population. Of 88 articles, 7 were used to develop the contraceptive counseling model. The model follows the following steps: 1. Addressing the information related to the need for contraception; 2. Evaluation of contraindications to the use of contraceptive methods (hormonal and nonhormonal); and 3. Side effects and possible discomfort associated with the use of contraception. The contraceptive counseling model is composed of 18 questions that address the indications and contraindications to the use of these methods, and a flowchart to assist patients in choosing a method that suits their needs.
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Affiliation(s)
- Sérgio Henrique Pires Okano
- Universidade de Ribeirão Preto, Ribeirão Preto, SP, Brazil.,Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | | | - Giordana Campos Braga
- Universidade de Ribeirão Preto, Ribeirão Preto, SP, Brazil.,Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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McCracken M, DeHaan G, Obedin-Maliver J. Perinatal considerations for care of transgender and nonbinary people: a narrative review. Curr Opin Obstet Gynecol 2022; 34:62-68. [PMID: 35102108 DOI: 10.1097/gco.0000000000000771] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The visibility of the lesbian, gay, bisexual, transgender, and queer (LGBTQ+) communities, specifically the transgender and nonbinary (TGNB) communities, continues to grow. However, there is little description, much less guidance toward optimizing, the pregnancy-related care of TGNB people. The overarching goal of this paper is to provide guidance that aids in reimagining obstetrics to include people of all genders. RECENT FINDINGS This article will review current literature and provide recommendations specific to the hospital birthing environment to help address the lack of knowledge regarding pregnancy-related care of TGNB individuals. This care is further divided into three main times: (1) preconception, antepartum care, and triage, (2) intrapartum, and (3) postpartum. We also discuss considerations for the general medical care of TGNB individuals. SUMMARY Understanding facilitators and barriers to gender affirming pregnancy-related care of TGNB individuals are first steps toward providing a respectful, affirming, and evidence-based environment for all patients, especially TGNB individuals. Here we provide context, discussion, and resources for providers and TGNB patients navigating pregnancy-related care. Lastly, this review challenges researchers and clinicians with future directions for the care of TGNB individuals in this continually expanding field.
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Affiliation(s)
- Megan McCracken
- Department of Obstetrics and Gynecology Stanford University School of Medicine, Stanford, California
| | - Gene DeHaan
- Department of Obstetrics and Gynecology Kaiser Permanente, Portland, Oregon
| | - Juno Obedin-Maliver
- Department of Obstetrics and Gynecology Stanford University School of Medicine, Stanford, California
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA
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Forsberg H, Eliason MJ. Healthcare Providers' Pregnancy Prevention Counseling of Trans and Non-Binary Assigned Female at Birth (TNB/AFAB) Patients. JOURNAL OF HOMOSEXUALITY 2022; 69:356-383. [PMID: 32960736 DOI: 10.1080/00918369.2020.1819713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Transgender and non-binary people assigned female at birth (TNB/AFAB) have unintended pregnancies, but there is a dearth of information about effective pregnancy prevention care for this population. This needs assessment study aimed at discerning pregnancy prevention care best practices involved interviews of 20 healthcare providers solicited for experience providing pregnancy counseling with this group. Findings were organized via the ecological model, revealing four layers of themes. 1) Social structural level themes related to the gender binary system and other forms of oppression (racism, sexism, heterosexism); 2) the systems level theme related to access to and barriers to care; 3) provider level themes included lack of formal education, need to provide trauma-informed care, and provider discomfort or assumptions; and 4) patient-level themes included the fact that patients do not usually raise issues related to contraception and that TNB/AFAB patients have unique contraception needs. Implications of the findings are discussed.
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Affiliation(s)
- Hannah Forsberg
- Department of Health Education, San Francisco State University, San Francisco, California, USA
| | - Michele J Eliason
- Department of Health Education, San Francisco State University, San Francisco, California, USA
- San Francisco State University, San Francisco, California, USA
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Sims LB, Appenroth MN. Contraceptive technology research & development: a call for inclusion of trans and gender diverse individuals assigned female at birth. EUR J CONTRACEP REPR 2021; 27:142-147. [PMID: 34845964 DOI: 10.1080/13625187.2021.2000960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Increased research efforts over the past decade provide a more in-depth understanding of the diverse fertility desires and family planning needs of trans and gender diverse individuals assigned female at birth (TGD AFAB). Despite this increased understanding and unmet need, global health researchers and contraceptive product developers have yet to include TGD AFAB individuals and considerations of their needs in the product development process, marginalising this historically underrepresented population. The aim of this perspective is to present the case for inclusion of TGD AFAB individuals in contraceptive research. MAIN OUTCOMES This perspective summarises the most recent literature characterising contraceptive access and use within TGD AFAB populations as well as the barriers to use. Furthermore, this perspective offers insight into how novel contraceptive technologies in the research and development pipeline could potentially appeal to TGD AFAB populations and recommends steps product developers can make towards being more inclusive. CONCLUSIONS With current research efforts in contraceptive product development aimed at expanding the method mix to appeal to a more diverse population of potential users, it behoves product developers to be more inclusive of TGD AFAB individuals in the development process and consider them as stakeholders of an expanded contraceptive method mix.
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Affiliation(s)
- Lee B Sims
- United States Agency for International Development, Global Health Technical Professionals Program, Public Health Institute
| | - Max N Appenroth
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Abern L, Krempasky C, Diego D, De Guzman G, Kiely K, Cook J, Maguire K. The Intrauterine Device Experience Among Transgender and Gender-Diverse Individuals Assigned Female at Birth. J Midwifery Womens Health 2021; 66:772-777. [PMID: 34767305 DOI: 10.1111/jmwh.13310] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 09/15/2021] [Accepted: 10/11/2021] [Indexed: 01/16/2023]
Abstract
INTRODUCTION The intrauterine device (IUD) is a long-acting and highly efficacious form of contraception that can also be used for menstrual suppression. Although IUD use is increasing, the type chosen, appeal, and satisfaction among individuals who are transgender and gender diverse and assigned female at birth (TGD-AFAB) is unknown. The purpose of this study is to evaluate IUD usage among TGD-AFAB individuals. METHODS TGD-AFAB individuals who had an IUD for a minimum of 6 months at the time of completing the survey or had one in the past completed an anonymous online survey. Descriptive statistics were used to analyze the data. RESULTS One hundred and five TGD-AFAB individuals completed the survey. Among participants who were sexually active, 88% reported they were in a relationship in which it was possible to get pregnant. There were 85 individuals who currently had an IUD: 62 (73%) chose a 52-mg levonorgestrel (LNG) IUD, 5 (6%) chose a lower-dose LNG IUD, 17 (20%) chose the copper IUD, and one chose an IUD unavailable in the United States. Menstrual suppression was the primary reason for choosing a 52-mg LNG IUD (58%). Most individuals who opted for a copper IUD did so to avoid hormonal contraception (71%). Participants reported experiencing IUD side effects; however, few desired removal. Among the 36 respondents who had an IUD in the past, the most frequent reasons for removal were expiration of the device (LNG IUDs) and undesired side effects (copper IUD). Approximately half of participants who had an IUD removed had it replaced with another IUD. DISCUSSION Pregnancy can occur among TGD-AFAB individuals even if they are on testosterone and amenorrheic. IUDs are well tolerated in this population, with few current users desiring removal for unwanted side effects. Clinicians should counsel TGD-AFAB individuals about the contraceptive and noncontraceptive benefits of IUDs and expected side effects.
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Affiliation(s)
| | | | | | | | | | - Jake Cook
- Philadelphia Fight, Philadelphia, Pennsylvania
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9
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Reynolds CA, Charlton BM. Pregnancy prevention and unintended pregnancy across gender identity: a cross-sectional study of college students. Sex Health 2021; 18:441-443. [PMID: 34731596 DOI: 10.1071/sh21103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 09/29/2021] [Indexed: 11/23/2022]
Abstract
Using data from the Fall 2015 through Spring 2018 National College Health Assessment, we examined receipt of pregnancy prevention information and unintended pregnancy by gender identity among participants aged 18-25years who were assigned female at birth (n=185658). Non-binary students were more likely than cisgender students to report wanting (adjusted risk ratio [ARR]: 1.12; 95% CI: 1.08-1.16), receiving (ARR: 1.09; 95% CI: 1.04-1.13), and having an unmet need for (ARR: 1.10; 95% CI: 1.02-1.19) pregnancy prevention information from their school. Transmasculine students did not significantly differ from cisgender students for these outcomes. Non-binary and transmasculine students were as likely as cisgender students to have a past-year unintended pregnancy. Non-binary and transmasculine young people are at risk for unintended pregnancy and need access to comprehensive sexual education, reproductive health counseling, and care.
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Affiliation(s)
- Colleen A Reynolds
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; and Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Brittany M Charlton
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; and Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA; and Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
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Ellis SA. From Here to Enough: Fulfilling Midwives' Responsibility to Our Patients and Our Profession. J Midwifery Womens Health 2021; 66:715-716. [PMID: 34693627 DOI: 10.1111/jmwh.13308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 09/26/2021] [Indexed: 11/28/2022]
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Lowik A. "Just because I don't bleed, doesn't mean I don't go through it": Expanding knowledge on trans and non-binary menstruators. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2021; 22:113-125. [PMID: 34568874 PMCID: PMC8040688 DOI: 10.1080/15532739.2020.1819507] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVES Critical menstruation studies is a field in its nascence, marginalized within the broader area of reproductive health research. Menstruation-related research is virtually absent from trans studies, itself a marginalized field of inquiry. This article focuses on the experiences of trans and non-binary menstruators, to contribute to this burgeoning area of study. METHODS This article involves secondary data analysis of a qualitative dissertation research study on trans people's reproductive lives, health, and decision-making processes. Of the fourteen participants in the broader study, eleven discussed their perceptions of and experiences with menstruation and menstrual health. Those experiences where subjected to thematic narrative analysis, with a focus on themes that were substantively significant. RESULTS Participants describe experiences with amenorrhea associated with the use of testosterone, menstrual resumption following the cessation of testosterone and for other reasons, menstruation-related dysphoria management strategies beyond medical interventions, as well as barriers to menstruation-related health care. One participant describes bloodless periods as a trans woman, a phenomenon altogether absent from the clinical and experiential literature in this field. The article explores how cisnormativity, repronormativity and transnormativity informed the participants experiences of menstruation and reproductive health care. CONCLUSIONS Contributing novel stories to the literature, this article illustrates how clinically focused research fails to attend to the experiential components of menstruation for trans and non-binary people. Expanded knowledge is beneficial to the development of gender-inclusive menstruation research, clinical interventions, healthcare environments, and activist efforts.
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Affiliation(s)
- A.J. Lowik
- Institute for Gender, Race, Sexuality and Social Justice, University of British Columbia, Vancouver, Canada
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12
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Contraception across transgender. Int J Impot Res 2021; 33:710-719. [PMID: 33558672 DOI: 10.1038/s41443-021-00412-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 11/09/2022]
Abstract
Sexual and reproductive issues are essential elements of well-being in cisgenders as well as for the transgender population. Gender-affirming hormonal treatments (GAHTs) aim to induce phenotypical changes congruent with the desired gender and subsequent reduction of gender dysphoria. While genital surgical procedures including hysterectomy and/or adenectomy cause permanent loss of ability to conceive, GAHT may induce a varying degree of reversible loss of fertility. For these reasons, transgender men and women need to be counseled concerning contraceptive options and potential effects of treatment on reproductive function before initiating GAHT. The literature reports that sexual activity with genital involvement is performed by less than half of transgender persons who have been sexually active with a partner in the past. Testosterone (T) is the most commonly used compound in transmen and usually leads to amenorrhea within 1-12 months from first administration, however cessation of menses does not mean anovulation. Some studies report cases of unintended pregnancies among transgender men under masculinizing therapy, therefore T treatment cannot be considered a contraceptive option. Currently available contraceptive options have pros and cons in transmen and scarce literature exists on their use. The effects of GAHT on fertility in transwomen are even less well known. Prolonged estrogen exposure induces sperm suppression and morphological changes of the spermatozoa, however the degree of resulting pregnancy protection is unclear. Further research to inform the contraceptive counseling in this population is mandatory.
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Moseson H, Fix L, Hastings J, Stoeffler A, Lunn MR, Flentje A, Lubensky ME, Capriotti MR, Ragosta S, Forsberg H, Obedin-Maliver J. Pregnancy intentions and outcomes among transgender, nonbinary, and gender-expansive people assigned female or intersex at birth in the United States: Results from a national, quantitative survey. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2021; 22:30-41. [PMID: 34796363 PMCID: PMC8040680 DOI: 10.1080/26895269.2020.1841058] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Background: Transgender, nonbinary, and gender-expansive (TGE) people experience pregnancy. Quantitative data about pregnancy intentions and outcomes of TGE people are needed to identify patterns in pregnancy intentions and outcomes and to inform clinicians how best to provide gender-affirming and competent pregnancy care. Aims: We sought to collect data on pregnancy intentions and outcomes among TGE people assigned female or intersex at birth in the United States. Methods: Collaboratively with a study-specific community advisory team, we designed a customizable, online survey to measure sexual and reproductive health experiences among TGE people. Eligible participants included survey respondents who identified as a man or within the umbrella of transgender, nonbinary, or gender-expansive identities; were 18 years or older; able to complete an electronic survey in English; lived in the United States; and were assigned female or intersex at birth. Participants were recruited through The PRIDE Study - a national, online, longitudinal cohort study of sexual and gender minority people - and externally via online social media postings, TGE community e-mail distribution lists, in-person TGE community events, and academic and community conferences. We conducted descriptive analyses of pregnancy-related outcomes and report frequencies overall and by racial and ethnic identity, pregnancy intention, or testosterone use. Results: Out of 1,694 eligible TGE respondents who provided reproductive history data, 210 (12%) had been pregnant. Of these, 115 (55%) had one prior pregnancy, 47 (22%) had two prior pregnancies, and 48 (23%) had three or more prior pregnancies. Of the 433 pregnancies, 169 (39%) resulted in live birth, 142 (33%) miscarried, 92 (21%) ended in abortion, two (0.5%) ended in stillbirth, two (0.5%) had an ectopic pregnancy, and seven (2%) were still pregnant; nineteen pregnancies (4%) had an unknown outcome. Among live births, 39 (23%) were delivered via cesarean section. Across all pregnancies, 233 (54%) were unintended. Fifteen pregnancies occurred after initiation of testosterone, and four pregnancies occurred while taking testosterone. Among all participants, 186 (11%) wanted a future pregnancy, and 275 (16%) were unsure; 182 (11%) felt "at risk" for an unintended pregnancy. Discussion: TGE people in the United States plan for pregnancy, experience pregnancy (intended and unintended) and all pregnancy outcomes, and are engaged in family building. Sexual and reproductive health clinicians and counselors should avoid assumptions about pregnancy capacity or intentions based on a patient's presumed or stated gender or engagement with gender-affirming hormone therapy.
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Affiliation(s)
- Heidi Moseson
- Ibis Reproductive Health, Oakland, California, USA
- CONTACT Heidi Moseson Ibis Reproductive Health, 1736 Franklin Street, Suite 600, Oakland, CA94116, USA
| | - Laura Fix
- Ibis Reproductive Health, Cambridge, Massachusetts, USA
| | - Jen Hastings
- Department of Family and Community Medicine, University of California, San Francisco, California, USA
| | - Ari Stoeffler
- Planned Parenthood of Massachusetts, Boston, Massachusetts, USA
| | - Mitchell R. Lunn
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
- The PRIDE Study/PRIDEnet, Stanford University, Stanford, California, USA
| | - Annesa Flentje
- Department of Community Health Systems, University of California, San Francisco, California, USA
- The PRIDE Study/PRIDEnet, Stanford University, Stanford, California, USA
- Alliance Health Project, Department of Psychiatry, University of California, San Francisco, California, USA
| | - Micah E. Lubensky
- The PRIDE Study/PRIDEnet, Stanford University, Stanford, California, USA
| | - Matthew R. Capriotti
- The PRIDE Study/PRIDEnet, Stanford University, Stanford, California, USA
- Department of Psychology, San José State University, San Jose, California, USA
| | | | | | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Stanford University, Stanford, California, USA
- Department of Obstetrics and Gynecology, Stanford University School of MedicineStanford, California, USA
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Rabelais E. Missing Ethical Discussions in Gender Care for Transgender and Non‐binary People: Secondary Sex Characteristics. J Midwifery Womens Health 2020; 65:741-744. [DOI: 10.1111/jmwh.13166] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 08/01/2020] [Accepted: 08/06/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Em Rabelais
- Department of Women, Children, and Family Health Science, College of Nursing University of Illinois at Chicago Chicago Illinois
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15
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Gomez AM, Đỗ L, Ratliff GA, Crego PI, Hastings J. Contraceptive Beliefs, Needs, and Care Experiences Among Transgender and Nonbinary Young Adults. J Adolesc Health 2020; 67:597-602. [PMID: 32527572 DOI: 10.1016/j.jadohealth.2020.03.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/18/2020] [Accepted: 03/01/2020] [Indexed: 01/09/2023]
Abstract
PURPOSE This qualitative study explores the contraceptive health-care needs of transgender and nonbinary young adults assigned female sex at birth. METHODS Qualitative interviews were conducted with 20 transgender and nonbinary young adults assigned female sex at birth (ages 22-29 years), recruited via online platforms and community agencies. Semistructured interviews elicited information on participants' gender and reproductive histories, health-care experiences, sexual practices, and contraceptive use and decision-making processes. Interviews were transcribed and coded using thematic analysis. RESULTS Primary thematic domains centered on contraceptive experiences and needs, testosterone as contraception, and experiences with reproductive health care. Participants generally did not use hormonal contraception to prevent pregnancy; in situations where pregnancy was possible, participants relied on condoms. Some participants believed testosterone use would prevent pregnancy and subsequently did not use a contraceptive method. Participants described the lack of knowledge, among themselves and providers, of the impacts of testosterone on pregnancy risk and interactions with hormonal contraception. They described reproductive health-care experiences in which providers were unfamiliar with the needs of transgender and nonbinary patients; made assumptions about bodies, partners, and identities; and lacked adequate knowledge to provide effective contraceptive care. CONCLUSIONS Patient-centered reproductive care requires that providers be sensitive to the stress of gender-affirming care and engage with contraceptive counseling that addresses patients' behavior, risks, and reproductive functions. In particular, providers should understand and communicate the impacts of testosterone therapy on pregnancy risk.
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Affiliation(s)
- Anu Manchikanti Gomez
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, Berkeley, California.
| | - Lotus Đỗ
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, Berkeley, California
| | - G Allen Ratliff
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, Berkeley, California
| | - Pau I Crego
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, Berkeley, California
| | - Jen Hastings
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California; Gender Spectrum, Berkeley, California
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16
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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 female sex assigned at birth. Contraception 2020; 102:70-82. [DOI: 10.1016/j.contraception.2020.04.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 04/02/2020] [Accepted: 04/06/2020] [Indexed: 11/24/2022]
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17
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Likis FE, King TL. Gender Diversity and Inclusion in Midwifery. J Midwifery Womens Health 2020; 65:193-194. [PMID: 32277588 DOI: 10.1111/jmwh.13103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 02/26/2020] [Indexed: 11/27/2022]
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18
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Agénor M, Cottrill AA, Kay E, Janiak E, Gordon AR, Potter J. Contraceptive Beliefs, Decision Making and Care Experiences Among Transmasculine Young Adults: A Qualitative Analysis. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2020; 52:7-14. [PMID: 31977155 DOI: 10.1363/psrh.12128] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 10/21/2019] [Accepted: 10/31/2019] [Indexed: 05/16/2023]
Abstract
CONTEXT Transmasculine people-that is, individuals who were assigned female at birth and have a male or masculine gender identity-can experience unintended pregnancy. Yet research on contraception among transmasculine individuals is extremely limited. METHODS Participants were recruited online; from community-based organizations, health centers and student groups; and by chain referral. From purposive sampling, 21 transmasculine individuals aged 18-29 who resided in the greater Boston area and had had, in the last five years, a sexual partner who was assigned male at birth were selected for in-depth interviews. All interviews were conducted in person between February and May 2018 in Boston, and transcripts were analyzed using a thematic analysis approach involving inductive and deductive coding to identify themes and subthemes. RESULTS Most participants believed that contraceptive use was necessary to effectively prevent pregnancy among transmasculine individuals. Their beliefs and decisions regarding contraception occurred in the context of a lack of information about contraception among transmasculine people, especially those using testosterone. Many individuals chose a contraceptive method on the basis of whether it mitigated their gender dysphoria or stopped menstruation, and said they preferred condoms and implants because these methods provided fewer reminders of their natal anatomy and were not perceived as interfering with testosterone use. Gender bias, discrimination and stigma in patient-provider interactions and health care settings negatively influenced participants' contraceptive care experiences. CONCLUSIONS Health care providers and facilities should provide transmasculine people with tailored contraceptive information and care that address their specific gender-affirmation needs and contraceptive preferences in safe, inclusive and supportive clinical settings.
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Affiliation(s)
- Madina Agénor
- Department of Community Health, Tufts University, Medford, MA
| | | | - Eriko Kay
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston
| | - Elizabeth Janiak
- Department of Obstetrics and Gynecology, Brigham and Womens Hospital and Harvard Medical School, Boston
| | - Allegra R Gordon
- Department of Community Health Sciences, Boston University School of Public Health, Boston
| | - Jennifer Potter
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston
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19
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Barger MK. Current Resources for Evidence-Based Practice, January/February 2020. J Midwifery Womens Health 2020; 65:165-171. [PMID: 31977141 DOI: 10.1111/jmwh.13079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 11/27/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Mary K Barger
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, San Diego, California
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