You and your body

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

Some women assume they can't get pregnant while they are breastfeeding as their periods haven’t started again after pregnancy, and 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 is probably safest to assume the same is true for us.

Hormonal contraceptives are not an option once you start on T, as the contraceptive pill contains high levels of female hormones (which is not what you want if you’re taking testosterone). Condoms, Femidoms and the cervical cap are all barrier methods which stop sperm getting into the uterus, and although no contraception method is 100 per cent effective, correctly using a barrier method and testosterone would make an effective combination to prevent a pregnancy.

If you are on T you won't be able to use the morning after pill for the same reasons that you can’t use hormonal contraceptives - as the interactions between hormones could cause problems. However, it’s worth noting that there isn’t anything specifically in the prescribing notes in relation to testosterone interactions - as they don’t expect men to ask for the morning after pill.

If you’re not on T, hormonal contraceptives will still work for you, but remember that they don’t offer any protection against sexually transmitted infections (STIs). Find out more information about protecting yourself and your partners from STIs.

Over the past few years there have been several instances of transmen 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 have had any genital surgery it will make things much more complicated, if not impossible.

It is 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 have been taking testosterone your body would need time for the ovaries to start working normally again, and there is 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 is 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.

Many transmen 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.ftm.underworks.com are a popular solution, as are chest binders from www.t-kingdom.com.

Some transmen just wear sports bras as they can flatten the chest somewhat but still support the breasts. If you are interested in binding, it is 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. Above this can be harder to flatten, but binding in combination with loose or layered clothing can disguise a larger chest.

If you are 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.

Binding can, however, cause damage to the chest so it is not advisable to wear a binder 24-hours-a-day, nor to bind so tightly that it is 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 will probably get sweaty. It is worth bearing in mind that binding can cause changes to the breast tissue - but it is unknown whether there are any long-term risks.

While binding, even if you are taking testosterone, you are still at risk of breast cancer and are advised to do monthly checks for lumps. If you have had surgery there is 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 transmen to interact with some parts of their bodies, such as the chest, but it is 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:

• 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 is 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.