Pregnancy and Birth Control

Planning to get pregnant? You might consider:

• freezing your eggs for later use, especially if you plan to have a hysterectomy 
• stopping testosterone and attempting to conceive (e.g., through sex, in vitro fertilization, etc.)
• surrogacy (note: In Canada, surrogacy is legal but with some restrictions, so it’s worth doing your research first).

Resources for us do exist. For example, check out the LGBTQ Parenting Network. Some of us also use pregnancy/birthing providers and doulas who are queer- and trans-friendly.

Testosterone isn’t birth control. For those of us who have our uteruses, pregnancy is still a possibility.

Most contraception methods don’t interfere with testosterone therapy or alter its masculinizing effects. 

In this guide, we’ve already discussed two kinds of contraception—internal and external condoms (see “Stocking Your Safer Sex Stash”). Below are two more options: the Pill and the intrauterine device (IUD). 

Note that—unlike condoms—the Pill and IUDs don’t protect you from STIs.

The Pill
Birth control pills (“the Pill”) contain hormones that can prevent pregnancy. 

Some versions of the Pill contain estrogen. There’s no data or anecdotal evidence that’s shown that versions of the Pill with estrogen interfere with T’s masculinizing effects. However, if you prefer, it’s also possible to take versions of the Pill that contain no estrogen and instead contain a hormone called progesterone. 

Regardless of what version of the Pill you take, you can safely take T and be on the Pill at the same time. 

Pros

• Less invasive than IUDs.
• Can also be used to stop periods.

Cons

• Potential for side effects. Some of these, like soreness in the chest area and spotting, may trigger gender dysphoria. (Note: Side effects from the Pill usually go away in 2 to 3 months.)
• May interfere with some medications, including certain HIV meds.

IUDs
An IUD is a T-shaped rod that’s inserted into the uterus via the front hole.

There are two main types of IUDs:

• Hormonal IUDs release small amounts of progesterone, which helps to regulate cycles (note: using a hormonal IUD won’t interfere with the masculinizing effects of T).
• Copper IUDs are hormone-free and might be good for people who don’t want to be on any (additional) hormones.

Pros

• Can last for 3 to 5 years (hormonal IUDs) or 3 to 10 years (copper IUDs), depending on the brand.
• Hormonal IUDs can be used to stop periods.

Cons

• An IUD must be inserted and replaced by a doctor or nurse practitioner.
• Potential risks and side effects, like problems with insertion, breakthrough bleeding and spotting (for hormonal IUDs), and heavier periods and/or period pain (for copper IUDs).

Abortion can be done surgically or pharmaceutically (using pills). You can discuss with a doctor which option is best for you. If you’re on T, getting an abortion (either surgically or pharmaceutically) generally won’t interfere with this, and vice versa. 

For details about abortion coverage in your province, check out Action Canada.