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Contraception, pregnancy and chest care

a trans guy with his arms behind his head

A guide to childbirth, contraception and chest care for the trans man.

  1. Contraception
  2. Pregnancy
  3. Chest care

Contraception

If you're having vaginal sex with a cis male partner then you need to consider contraception, unless you want to get pregnant. If you're taking testosterone (T) and your periods have stopped or are very irregular, you're unlikely to conceive - but it isn't impossible.

Some women assume they can't get pregnant while they're breastfeeding as their periods haven’t started again after pregnancy. Women with polycystic ovary syndrome (PCOS) can have very high testosterone levels, leading to irregular or absent periods. While many women in these situations do find it hard to get pregnant, it does still happen. It's probably safest to assume the same is true for us.


What are the best contraceptive methods for trans men?

CondomsFemidoms and the cervical cap are all barrier methods which stop sperm getting into the uterus. Although no contraception method is 100% effective, correctly using a barrier method and testosterone would make an effective combination to prevent a pregnancy.

If you're on T you can use hormonal contraceptives that are progesterone-based (but not the oestrogen-based ones). This applies to the morning-after pill Levonelle as it's progesterone-based.

There is not much information online about this but anecdotally we know that trans men are using progesterone-based contraceptives including the progestogen-only pill, the contraceptive implant or the intrauterine device (IUD). However, bear in mind that these may cause bleeding - please speak to your clinician to get advice about the best contraceptive options for you.

If you’re not on T, any hormonal contraceptives will work for you, but remember that they don’t offer any protection against HIV and sexually transmitted infections (STIs). 

Find out more about protecting yourself and your partners from STIs.


Last updated: 9 October 2017

Pregnancy

Over the past few years there have been several instances of trans men stopping their testosterone specifically to get pregnant, and going on to have normal pregnancies with healthy children. Of course, this is only possible if you haven’t had a hysterectomy. If you've had any genital surgery it will make things much more complicated, if not impossible.

It's likely that you would have to stop testosterone for some time before you could conceive. Women who have been on the contraceptive pill for a long time often find it takes several months for their hormones to regulate themselves. If you've been taking testosterone your body would need time for the ovaries to start working normally again, and there's no guarantee that they will at all.

Always consult your doctor or specialist before stopping any medication as it can be quite a shock to your system - you should be monitored as though you had just started taking hormones. If you plan to have a child you need to consider the possibility that people around you may react negatively, even in the media or sometimes in clinics also.

Although it shouldn't make any difference, many people do have problems with the idea of a man carrying a child. You should be prepared for some challenging attitudes and questions around whether you should be doing it, or whether it makes you less of a man if you do, even if these might seem ignorant or ill-informed.

Although there is no specific ruling on the subject, it's highly unlikely that you will get NHS funding for any fertility treatment you might need, and private fertility treatment is a very expensive process.

You might find it helpful to get some advice from your local contraceptive and fertility service.

Chest care

Many trans men bind their breasts to create a flatter, more masculine appearance. This can be done in a variety of ways. Some use bandages, elastic or other materials wrapped around and pinned to hold it in place. Compression vests from companies such as www.f2mbinders.com are a popular solution, as are chest binders from www.t-kingdom.com and Underworks.

Some trans men just wear sports bras as they can flatten the chest somewhat but still support the breasts. If you're interested in binding, it's worth experimenting with different methods to find solutions that you find comfortable, wearable and practical. The results you get will depend on the method you use and the size of your chest. Chests which are a D-cup and below tend to flatten down successfully with binding. Sizes above this can be harder to flatten, but binding in combination with loose or layered clothing can disguise a larger chest.


Will my chest become flatter overtime?

If you're taking testosterone you may find that it causes the chest to get slightly easier to bind.

Likewise frequent binding itself will, over time, cause the flesh of the chest to become less firm, making it easier to bind. The difference isn’t huge but can make binding more comfortable.


Does binding have any health risks?

Binding can indeed cause damage to the chest - so it's not advisable to wear a binder 24-hours-a-day, nor to bind so tightly that it's painful. Binding too tightly may cause breathing problems, so make sure you can expand your ribcage comfortably.

Binding for long periods without a break, or binding very tightly, can cause skin rashes - especially in summer when you'll probably get sweaty.

Bear in mind that binding can cause changes to the breast tissue - but it's unknown whether there are any long-term risks.

While binding, even if you're taking testosterone, you're still at risk of breast cancer and are advised to do monthly checks for lumps.


Does top surgery eliminate the risk of breast cancer?

If you've had surgery there's still a small risk of breast cancer – two per cent of all breast cancer cases are in men. We know it can be difficult for trans men to interact with some parts of their bodies, such as the chest, but it's still important to become familiar with it so you can recognise any changes.

NHS Choices advises checking your breasts regularly and looking for any of the following:

  • Changes in the outline or shape of the breast, especially those caused by arm movements or by lifting the breast.
  • Changes in the look or feel of the skin, such as puckering or dimpling.
  • Discomfort or pain in one breast that is unusual, particularly if it's new and persistent. 
  • Any new lumps, thickening or bumpy areas in one breast or armpit which differs from the same part of the other breast and armpit.
  • Nipple discharge that's new for you and not milky.
  • Bleeding from the nipple.
  • Moist, red areas on the nipple that don't heal easily.
  • Any change in nipple position, such as pulled up or pointing differently.
  • A rash on or around the nipple.

If you notice any of these changes, see your GP.

 

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The Information Standard: Certified member

This article was last reviewed on 24/3/2015 by Anna Peters

Date due for the next review: 24/3/2018

Content Author: Aedan Walton

Current Owner: Michelle Ross

More information:

Contraception guide – which method of contraception suits me?
NHS Choices
February 2016

The progestogen-only pill
NHS Choices
December 2014

Emergency contraception
NHS Choices
January 2015

Contraceptive injection
NHS Choices
January 2015

Pelvic pain and persistent menses in transgender men
Primary author: Juno Obedin-Maliver, MD, MPH
Center of excellence for transgender health
University of California
2017

Trans care - Gender transition
Vancouver Coastal Health, Transcend Transgender Support & Education Society and Canadian Rainbow Health Coalition
February 2006

Should trans men have a hysterectomy?
Dr Richard Curtis
Gires
August 2014

NHS Choices. Breast cancer awareness. 18/06/2012

University of Michigan Health System. Binding.

Vancouver Coastal Health Website. Transgender Health Program. Surgery, A Guide for FTMs, FTM Chest Surgery, ‘What about binding?’ A. J. Simpson, Joshua Goldberg. (2006)

Vancouver Coastal Health Website. Transgender Health Program.
Hormones: A Guide for FTMs, ‘4. ‘Hormone therapy won’t remove all “female”/“feminine” aspects of your body’. Olivia Ashbee & Joshua Goldberg. (2006)

NHS Choices. Breast Cancer in Men. (2011)

Wylie, C et al, Endocrine Treatment of Transsexual Persons: An Endocrine Society Clinical Practice Guideline, p3139, Journal of Clinical Endocrinology & Metabolism, The Endocrine Society (2009) 

NHS Choices. Polycystic ovary syndrome. (2012)

NHS Choices. Contraception. (2012)

NHS Choices. Hysterectomy. (22/2/2012)

The Endocrine Society Endocrine Treatment of Transsexual Persons: An Endocrine Society Clinical Practice Guideline Wylie, C et al. Journal of Clinical Endocrinology & Metabolism (2009)

GIRES. Gender Identity research and Education Society. A guide to hormone therapy for trans people, Trans wellbeing and healthcare (2007)

Vancouver Coastal Health, Transcend Transgender Support & Education Society and Canadian Rainbow Health Coalition. Surgery: A guide for FTMs:A. J. Simpson and Joshua Mira Goldberg (February 2006)

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