Birth Control

Sexual & Reproductive Healthcare for the Transgender and Nonbinary Community

2 min read

We know that the transgender and nonbinary communities face discrimination in healthcare. At Twentyeight Health, we welcome anyone who needs access to birth control. We’re here to offer education and access for all.

Here are some common questions to help guide you:

Do I need birth control?
‍Transgender men and nonbinary people assigned female at birth can still become pregnant and may be in need of birth control. Gender-affirming hormone therapy will not prevent pregnancy, and ovulation can still occur even without a regular period.

If you choose to have gender-affirming surgery, you will have to speak with your doctor about whether birth control is necessary.

Transgender women and nonbinary people assigned male at birth who have a penis can use condoms to prevent pregancy if their partner has a uterus. If their partner also has a penis, condoms are still a great option to prevent STIs.

What type of birth control is most appropriate for me?
‍According to the American College of Obstetricians and Gynecologists (ACOG), transgender and nonbinary folks can choose any method of birth control available to cigender women (if approved by a doctor).

There are many birth control options available to prevent pregnancy, such as birth control pills, the ring, the patch, the IUD, the shot, or the implant. Some of these methods contain a combination of estrogen and progestin, some just progestin, and one specific type of IUD has no hormones at all. Many of these options can help you skip or stop your period if that’s important to you, as well as address other concerns such as cramping, acne, etc. The doctors at Twentyeight will help you choose a birth control that’s medically appropriate and meet your goals. It’s important to keep in mind that none of these options protect against STIs, only condoms can do that.

Does birth control affect my gender-affirming hormone therapy?
‍Contraception that contains hormones may affect the dose required for the hormonal therapy. Therefore the doctor who provides your hormonal therapy should be made aware that you are on birth control. Being on testosterone is not a contraindication for using birth control that contains estrogen. It is uncommon for the estrogen in birth control to bring on more traditionally “feminine” traits, but if it still concerns you, there are other birth control options that are estrogen-free.

What can I expect from the doctors at Twentyeight?
‍The doctors provide a supportive, welcoming environment. You can sign up for a phone call if you have specific questions, and message with the doctor for free - anytime! The doctors are able to prescribe birth control, but Twentyeight does not offer gender-affirming hormonal therapy at this time. You may be asked medical questions such as:

What medications are you currently on?
What medical conditions do you have?
Have you had a recent surgery or a planned surgery soon?

If you have any suggestions on how Twentyeight can continue to be more inclusive of transgender & nonbinary reproductive rights, we’d be happy to hear from you! Email us at contact@twentyeighthealth.com.

Definitions

Cisgender: A term used to describe a person whose gender identity aligns with those typically associated with the sex assigned to them at birth. (From Human Rights Campaign)
Contraindication: a sign that someone should not continue with a particular medicine or treatment because it is or might be harmful. (From Cambridge Dictionary)

Nonbinary: The idea that there are only two genders is sometimes called a “gender binary,” because binary means “having two parts” (male and female). Therefore, “nonbinary” is one term people use to describe genders that don’t fall into one of these two categories, male or female. (From The National Center for Transgender Equality)
Progestin and Estrogen: Progestin is a form of progesterone, a hormone that plays a role in the menstrual cycle and pregnancy. Progestin is used in combination with another hormone called estrogen in combined hormonal birth control pills, the vaginal ring, and the skin patch. It also can be used by itself in progestin-only pills and the birth control injection. (From American College of Obstetricians and Gynecologists)
Testosterone: Testosterone is a hormone found in humans, as well as in other animals. The testicles primarily make testosterone. Ovaries also make testosterone, though in much smaller amounts. (From Healthline)
Transgender: Transgender people are people whose gender identity is different from the gender they were thought to be at birth. (From The National Center for Transgender Equality)