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Birth Control for Transgender Patients

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BIRTH CONTROL ACROSS THE GENDER SPECTRUM

Being safe from unplanned pregnancies can reduce anxiety or stress connected with sex and make it more enjoyable. HealthQ offers respectful, quality care when it comes to sexual health, and we can help you understand your options as far as birth control for transgenders.

CAN YOU GET PREGNANT?

If you have a uterus and ovaries, you can get pregnant. This is true even if you take testosterone. Although it may stop your monthly bleeding, testosterone does not keep you from getting pregnant.

CAN YOU GET SOMEONE PREGNANT?

If you have a penis and testes, you can get someone pregnant. This is true even if you take estrogen. Estrogen may lower your sperm count, but it does not keep you from getting someone pregnant.

BIRTH CONTROL FOR PEOPLE TAKING ESTROGEN

People who have a penis and testes and who take estrogen (along with their partners) can choose any birth control method.

PERMANENT OPTIONS

Permanent methods are great for people who don’t ever want to get pregnant. These include tubal ligation, Essure, hysterectomy, orchiectomy, and vasectomy.

BIRTH CONTROL FOR PEOPLE TAKING TESTOSTERONE

People who have a uterus and ovaries and who take testosterone can use any birth control method. The progestin pill, implant, IUD, and shot may help decrease monthly bleeding. Some people use one of these methods just to control bleeding, even if they don’t need birth control. Progestin does not interact with testosterone. Methods with estrogen (pill/patch/ring) may counter the effects of testosterone, causing female traits—even so, people taking testosterone can choose a method with estrogen. The copper IUD prevents pregnancy and contains no hormones. Condoms prevent pregnancy and sexually transmitted infections (STIs).

DON’T FORGET ABOUT SEXUALLY TRANSMITTED INFECTIONS!

Condoms can prevent human immunodeficiency virus (HIV) and other STIs. There are two types of condoms, internal and external. Both types help to prevent pregnancy and infections.

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BIRTH CONTROL CHOICES
ACROSS THE GENDER SPECTRUM

Method

The Implant
Nexplanon®
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How well does it work?

> 99%

How to Use

A health care provider places it under the skin of the upper arm.

It must be removed by a health care provider.

Pros

It may last up to 5 years.

It often decreases cramps.

After 1 year, you may have no monthly bleeding at all.

It may lower the risk of uterine lining cancer, ovarian cancer, and polycystic ovary syndrome (PCOS).

Cons

May cause spotting.

It may cause mood changes.

Method

Progestin IUD
Liletta®, Mirena®, Skyla®, and others

How well does it work?

> 99%

How to Use

A health care provider places it in the uterus.

It is usually removed by a health care provider.

Pros

It works for 3 to 7 years, depending on which IUD you choose.

It may improve monthly bleeding and cramps.

After 1 year, you may have no monthly bleeding at all.

It may lower the risk of uterine lining cancer, ovarian cancer, and polycystic ovary syndrome (PCOS).

Cons

May cause spotting.

Method

The Shot
Depo-Provera®

How well does it work?

94%

How to Use

Get a shot every 3 months.

You can get the shot at a health care office, or you can give yourself the shot.

Pros

Each shot works for 12 weeks.

It usually decreases monthly bleeding.

After 1 year, you may have no monthly bleeding at all.

It may lower the risk of uterine lining cancer, ovarian cancer, and polycystic ovary syndrome (PCOS).

Cons

It may cause spotting, weight gain, depression, hair or skin changes, or change in sex drive.

It may cause delay in getting pregnant after you stop the shots.

Side effects may last up to 6 months after you stop the shots.

Method

Progestin-Only Pills
Camila, Nor-QD® Micronor

How well does it work?

91%

How to Use

You must take the pill at the same time daily.

Pros

It’s easy to use.

It may lower the risk of uterine lining cancer, ovarian cancer, and polycystic ovary syndrome (PCOS).

Cons

It often causes spotting, which may last for many months.

It may cause depression, hair or skin changes, or change in sex drive.

Method

External Condom

How well does it work?

82%

How to Use

Use a new condom each time you have sex.

Use a polyurethane condom if allergic to latex.

Pros

Can buy at many stores.

Can put on as part of sex play/ foreplay.

Can help prevent early ejaculation.

Can be used for oral, vaginal, and anal sex.

Cons

Can decrease sensation.

Can cause loss of erection.

Can break or slip off.

Method

Internal Condom

How well does it work?

79%

How to Use

Use a new condom each time you have sex.

Use lubrication as needed.

Pros

Can put in as part of sex play/ foreplay.

Can be used for anal and vaginal sex.

May increase pleasure when used for anal and vaginal sex.

Good for people with latex allergy.

Cons

Can decrease sensation.

May be noisy.

May be hard to insert.

May slip out of place during sex.

Requires a prescription from your health care provider.

Method

Withdrawal
Pull-out

How well does it work?

78%

How to Use

Pull penis out of vagina before ejaculation (that is, before coming).

Pros

Costs nothing.

Cons

Less pleasure for some.

Does not work if penis is not pulled out in time.

Must interrupt sex.

Method

Diaphragm
Caya® and Milex®

How well does it work?

88%

How to Use

Must be used each time you have sex.

Must be used with spermicide.

Pros

Can last several years.

Costs very little to use.

May protect against some infections, but not HIV.

Cons

Using spermicide may raise the risk of getting HIV.

Should not be used with vaginal bleeding or infection.

Raises risk of bladder infection.

Method

Spermicide
Cream, gel, sponge, foam, inserts, film

How well does it work?

72%

How to Use

Insert spermicide each time you have sex.

Pros

Can buy at many stores.

Can insert as part of sex play/ foreplay.

Comes in many forms: cream, gel, sponge, foam, inserts, film.

Cons

May raise the risk of getting HIV.

May irritate vagina, penis.

Cream, gel, and foam can be messy.

Method

Emergency Contraception Pills
Progestin EC (Plan B One-Step® and others) and ulipristal acetate (ella®)

How well does it work?

58-94% Ulipristal acetate EC works better than progestin EC if you are overweight Ulipristal acetate EC works better than progestin EC in the 2-5 days after sex.

How to Use

Works best the sooner you take it after unprotected sex.

You can take EC up to 5 days after unprotected sex.

If pack contains 2 pills, take both together.

Pros

Available at pharmacies, health centers, or health care providers: call ahead to see if they have it.

People of any age can get progestin EC without a prescription, and it doesn’t interact with testosterone.

Cons

May cause stomach upset or nausea.

Your next monthly bleeding may come early or late.

May cause spotting.

Ulipristal acetate EC requires a prescription, and we don’t know whether or not it interacts with testosterone.

May cost a lot.

Method

The Pill

How well does it work?

91%

How to Use

Must take the pill daily.

Pros

It may improve monthly bleeding and cramps.

Can improve acne.

Helps prevent cancer of the ovaries.

Cons

May cause nausea, weight gain, headaches, change in sex drive.

May cause spotting in the first 1-2 months.

May counter the effects of testosterone.

Method

The Patch
Ortho Evra®

How well does it work?

91%

How to Use

Apply a new patch once a week for three weeks.

No patch on week 4.

Pros

It may improve monthly bleeding and cramps.

No pill to take daily.

Cons

Can irritate the skin under the patch.

May cause spotting in the first 1-2 months.

May counter the effects of testosterone.

Method

The Ring
Nuvaring®

How well does it work?

91%

How to Use

Insert a small ring into the vagina.

Change ring every month.

Pros

One size fits all.

Private.

Does not require spermicide.

It may improve monthly bleeding and cramps.

Cons

Can increase vaginal discharge.

May cause spotting in the first 1-2 months of use.

May counter the effects of testosterone.

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