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Transgender men and nonbinary people are asked to stop testosterone therapy during pregnancy – but the evidence for this guidance is still murky

Carla A. Pfeffer, Associate Professor of Social Work, Affiliate Faculty in Sociology and the Center for Gender in Global Context, and Director of the Consortium for Sexual and Gender Minority Health, Michigan State University, The Conversation on

Published in Health & Fitness

When I talk about our research team’s work on pregnancy in transgender people, people often recall Thomas Beatie, a pregnant man who appeared on “Oprah” and in People magazine in 2008. The media focus on Beatie and his pregnancy provoked public fascination that tended to overshadow the everyday lived realities of being pregnant as a trans person.

Transgender people, as opposed to cisgender people, have a gender identity that is different from the gender they were assigned at birth. Some may go on hormone therapy to help align their body with their gender identity. Like most trans men, Beatie went off testosterone during his pregnancy because it was medically advised as standard practice. But testosterone therapy is often essential to the mental and physical health of many trans men as well as some nonbinary people whose genders don’t fit within the categories of man or woman. What is the experience of pausing treatment like for them? Why do medical guidelines recommend going off testosterone?

As a sociologist who studies sex, gender and sexuality, and trans experiences of family, health and well-being, these questions piqued my interest. I work with an international team of researchers on a project about trans men and nonbinary people’s experiences of pregnancy. We interviewed 70 trans and nonbinary people who were either currently or intending to become pregnant, as well as 22 health care providers specializing in working with these communities, across seven countries.

While testosterone is widely considered a “male hormone,” all people produce testosterone. Physicians consider a wide range of testosterone levels to be “normal.”

Many transgender and nonbinary people take testosterone as part of their mental and physical health care. Testosterone therapy often results in a more masculine appearance through facial hair and muscle growth, fat redistribution and lowered vocal pitch.

In addition to physical changes, many of our study participants spoke of positive mental health improvements while on testosterone therapy, including feeling calmer, balanced and more fully themselves – sometimes for the first times in their lives. This is a common finding across research on hormone therapy and trans and nonbinary people.

 

While there’s no universal dosing protocol for trans or nonbinary people undergoing testosterone therapy, the Endocrine Society’s treatment guidelines recommend supplementing testosterone until blood ranges fall within those for cisgender men. By basing clinical standards on cisgender men, these guidelines can reproduce sex and gender binaries that may not fit with actual desires of many trans and nonbinary people. Some resist this prescriptive medical model by microdosing testosterone, with or without health care provider support.

When my team and I analyzed our research interviews, we learned that the health care providers in our study typically told their trans patients to stop testosterone therapy either six months before trying to get pregnant or immediately upon becoming aware of pregnancy. They also advised continuing to withhold testosterone therapy until either after birth or stopping chestfeeding (nursing their babies). This could mean a pause in testosterone therapy for up to two years.

Why do doctors tell trans and nonbinary patients to stop testosterone therapy during pregnancy?

The health care providers we interviewed expressed concerns about patients continuing testosterone while pregnant or chestfeeding. When we asked them what risks they were most concerned about, they often noted that there is either not enough or inconclusive research on using supplemental testosterone during pregnancy. Despite this, nearly all of the providers we interviewed routinely advised patients to pause testosterone therapy without reservation.

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